Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 04-37866 | KS |
Y | 2080P0202X | Pediatric Cardiologist | DR.0046762 | CO |
NPI | 1164608535 |
---|---|
Provider Name | Dr. Samuel Timothy Brescia |
First Address | Denver, CO 80205-5663 |
Second Address | Denver, CO 80205-5663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2008 |
Last Update Date | 07/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
88874745 | (05) | CO |