Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 20424 | CA |
NPI | 1083845887 |
---|---|
Provider Name | Stacey Amber Gerbrandt |
First Address | Valencia, CA 91355-4011 |
Second Address | Valencia, CA 91355-4011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2009 |
Last Update Date | 11/08/2020 |