Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | G30417 | CA |
Y | 2084N0400X | Neurologist | G30417 | CA |
NPI | 1013997766 |
---|---|
Provider Name | Ms. Nancy Lou Sajben |
First Address | La Jolla, CA 92120-1481 |
Second Address | La Jolla, CA 92037-1481 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 11/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B51071 | (02) | |
B51071 | (02) | CA |
G30417A | MEDICARE (01) | CA |