Individual
PAMELA BROSKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
72785 FRANK SINATRA DR, SUITE 101, RANCHO MIRAGE, CA 92270-3205
(760) 969-5900
(760) 969-5900
Mailing address
PO BOX 894830, LOCK BOX 4830, LOS ANGELES, CA 90189-4830
(760) 969-5900
(760) 969-5911
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
G61351
CA
207NS0135X
Procedural Dermatology Physician
G61351
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G613512
INDIVIDUAL PTAN
CA
01
—
070013862
RAILROAD MEDICARE
CA
Enumeration date
05/16/2006
Last updated
06/13/2013
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