Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A56126 | CA |
NPI | 1003995093 |
---|---|
Provider Name | Dr. Sharyn D. Brekhus |
First Address | Pomona, CA 91767-5900 |
Second Address | Pomona, CA 91767-2900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 13/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H23210 | (02) | CA |