Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A38800 | CA |
NPI | 1033121249 |
---|---|
Provider Name | Jacob Offenberger |
First Address | Granada Hills, CA 91344-6343 |
Second Address | Granada Hills, CA 91344-6343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 22/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C55513 | (02) | CA |