Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | G43200 | CA |
NPI | 1043328750 |
---|---|
Provider Name | Jean Grant Hawkins |
First Address | Northridge, CA 91324 |
Second Address | Northridge, CA 91324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G432000 | BLUE CROSS BLUE SHIELD (01) | |
A49268 | (02) | |
G43200 | STATE LICENSE (01) | |
GR0005950 | (05) | CA |
ZZZ90411Z | BLUE CROSS BLUE SHIELD GR (01) |