Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 12653 | NV |
N | 208600000X | Surgeon | 12653 | NV |
Y | 2086X0206X | Surgical Oncologist | 12653 | NV |
NPI | 1184748212 |
---|---|
Provider Name | Dr. Jennifer Lynn Baynosa |
First Address | Los Angeles, CA 90051-0596 |
Second Address | Las Vegas, NV 89102-2351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 27/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1184748212 | (05) | NV |
V51698 | PTAN (01) | NV |