Individual
DANIEL OLIN BROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
740 N. LAKE AVE, PASADENA, CA 91104
(626) 794-4668
(626) 345-9753
Mailing address
740 N. LAKE AVE, PASADENA, CA 91104
(626) 794-4668
(626) 345-9753
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A7759
CA
Other
Enumeration date
10/03/2006
Last updated
07/08/2007
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