Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G42766 | CA |
NPI | 1013097922 |
---|---|
Provider Name | Laura Bruckner |
First Address | Encino, CA 91316-5214 |
Second Address | Encino, CA 91316-5214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |