Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4254 | CA |
NPI | 1043389026 |
---|---|
Provider Name | Adam F Dustin |
First Address | Encinitas, CA 92024-8703 |
Second Address | Encinitas, CA 92024-8703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 11/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00E425400 | (05) | CA |
U75237 | (02) | CA |