Individual
JEAN GRANT HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD FCCP
Contact information
Practice address
18546 ROSCOE BLVD, #308, NORTHRIDGE, CA 91324
(818) 349-2931
(818) 349-7930
Mailing address
18546 ROSCOE BLVD, #308, NORTHRIDGE, CA 91324
(818) 349-2931
(818) 349-7930
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
G43200
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G432000
BLUE CROSS BLUE SHIELD
—
01
—
G43200
STATE LICENSE
—
05
—
GR0005950
—
CA
01
—
ZZZ90411Z
BLUE CROSS BLUE SHIELD GR
—
Enumeration date
08/25/2006
Last updated
07/08/2007
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