Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | A127343 | CA |
Y | 207N00000X | Dermatologist | DR.0056148 | CO |
NPI | 1023443918 |
---|---|
Provider Name | Dr. Neda R Black |
First Address | Los Angeles, CA 90089-0112 |
Second Address | Los Angeles, CA 90089-0112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2013 |
Last Update Date | 21/08/2016 |