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Individual
AMETRA BROOME
Active
Individual
AMETRA BROOME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20288
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0083640
—
CA
05
—
GR0083641
—
CA
01
—
ZZZ19972Z
MEDICARE GROUP
CA
01
—
ZZZ20075Z
MEDICARE GROUP
CA
Enumeration date
06/08/2009
Last updated
08/15/2014
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