Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | A169356 | CA |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | ME150241 | FL |
NPI | 1568071751 |
---|---|
Provider Name | Yael Emilie Bensoussan |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2020 |
Last Update Date | 12/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111057600 | (05) | FL |
QBLSW | BCBS (01) | FL |