Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | A60925 | CA |
NPI | 1003827056 |
---|---|
Provider Name | Kristin Elizabeth Nesburn |
First Address | Los Angeles, CA 90048-6101 |
Second Address | Los Angeles, CA 90048-6101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 17/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A609250 | (05) | CA |
H04800 | (02) |