Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A15204 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 20A15204 | CA |
NPI | 1760877302 |
---|---|
Provider Name | Shannon Rose Bell |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-1625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A15204 | STATE LICENSE (01) | CA |
FB7838177 | DEA (01) | CA |