Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 25MA10160900 | NJ |
N | 208600000X | Surgeon | 25MA10160900 | NJ |
Y | 208200000X | Surgeon | 300153-01 | NY |
Y | 208600000X | Surgeon | 300153-01 | NY |
N | 208200000X | Surgeon | LL32911 | SC |
N | 208600000X | Surgeon | LL32911 | SC |
N | 208200000X | Surgeon | Q9291 | TX |
N | 208600000X | Surgeon | Q9291 | TX |
NPI | 1003127366 |
---|---|
Provider Name | Dr. Vivian Jolley Bea |
First Address | Brooklyn, NY 11215-3609 |
Second Address | Brooklyn, NY 11215-3609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2010 |
Last Update Date | 11/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
366461701 | (05) | TX |