Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | A78457 | CA |
NPI | 1013027184 |
---|---|
Provider Name | Dr. Mary A. Vreeke |
First Address | Los Angeles, CA 90049-5131 |
Second Address | Oxnard, CA 93030-3722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 25/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A784570 | (05) | CA |
P00115702 | RAILROAD MEDICARE (01) | CA |