Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 28608 | FL |
NPI | 1407803430 |
---|---|
Provider Name | Ida Sebastian |
First Address | Boynton Beach, FL 33436-4426 |
Second Address | Lantana, FL 33462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D85887 | (02) |