Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A052670 | CA |
NPI | 1003042417 |
---|---|
Provider Name | Mel Eamon Herbert |
First Address | La, CA 90033 |
Second Address | Woodland Hills, CA 91364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2009 |
Last Update Date | 01/06/2009 |