Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 95006140 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95006140 | CA |
NPI | 1740728831 |
---|---|
Provider Name | Ginger Hulst |
First Address | Los Alamitos, CA 90720-8844 |
Second Address | Redondo Beach, CA 90277-7001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2017 |
Last Update Date | 10/12/2020 |