Individual
DAVID ALLAN BROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10833 LE CONTE AVE, LOS ANGELES, CA 90095-3075
(310) 301-6219
(310) 301-8751
Mailing address
5767 W CENTURY BLVD, SUITE 200, LOS ANGELES, CA 90045-5631
(310) 301-8708
(310) 301-8751
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
G82088
CA
2086X0206X
Surgical Oncology Physician
G82088
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G820880
—
CA
Enumeration date
05/24/2006
Last updated
11/16/2012
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