Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | A79183 | CA |
NPI | 1427129592 |
---|---|
Provider Name | Dr. Jessica Bren Boston |
First Address | Santa Monica, CA 90403-4803 |
Second Address | Santa Monica, CA 90403-4803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2006 |
Last Update Date | 23/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I35910 | (02) |