Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | A45464 | CA |
N | 208000000X | Pediatrician | A45464 | CA |
NPI | 1487725230 |
---|---|
Provider Name | Lynne Marie Bird |
First Address | San Diego, CA 92123-4800 |
Second Address | San Diego, CA 92123-2736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 30/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A454640 | (05) | CA |
00A454641 | (05) | CA |