Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G48150 | CA |
NPI | 1205918588 |
---|---|
Provider Name | Warren Scott Line JR. |
First Address | Burbank, CA 91505-4554 |
Second Address | Burbank, CA 91505-4554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 18/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6177618 | (05) | CA |
A92785 | (02) |