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Individual
PHALLA POV-BRANTLE
Active
Individual
PHALLA POV-BRANTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23738
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0043790
—
CA
01
—
ZZZ21572Z
GRP PTAN FOR BAZ ALLERGY, ASTHMA & SINUS CENTER
CA
Enumeration date
06/13/2014
Last updated
03/29/2016
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