Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 29287 | CA |
NPI | 1215047469 |
---|---|
Provider Name | Dr. Harold J Gulbransen |
First Address | La Mesa, CA 91942-3068 |
Second Address | La Mesa, CA 91942-3068 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 16/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B29287-01 | (05) | CA |
T70455 | (02) | CA |