Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | G36869 | CA |
NPI | 1336230366 |
---|---|
Provider Name | Dr. Jerome D Vener |
First Address | West Hills, CA 91307-1929 |
Second Address | West Hills, CA 91307-1929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 10/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46843 | (02) | CA |