Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | G48549 | CA |
Y | 207VX0000X | Obstetrician | G48549 | CA |
NPI | 1265460620 |
---|---|
Provider Name | Pamela Jean Johnston Boyer |
First Address | Los Angeles, CA 90095-8344 |
Second Address | Los Angeles, CA 90095-8344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 06/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G485490 | (05) | CA |
D38245 | (02) | CA |