Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | C28242 | CA |
NPI | 1639396120 |
---|---|
Provider Name | Theodore J. Eckberg |
First Address | Woodland Hills, CA 91367-6701 |
Second Address | Woodland Hills, CA 91367-6701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 23/09/2008 |