Provider Demographics
NPI:1558673632
Name:NOVEMBER BRYDEN, KARA DANIELLE (MD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:DANIELLE
Last Name:NOVEMBER BRYDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 OSOS ST SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401
Mailing Address - Country:US
Mailing Address - Phone:805-549-0888
Mailing Address - Fax:805-549-8463
Practice Address - Street 1:1235 OSOS ST SUITE 100
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401
Practice Address - Country:US
Practice Address - Phone:805-549-0888
Practice Address - Fax:805-549-8463
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA120063208000000X
CA390200000X
CA120063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA120063OtherMEDICAL LICENSE PHYSICIAN