Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO02162 | |
N | 222Z00000X | Podiatrist | CPO02162 | |
Y | 224P00000X | Prosthetist | CPO02162 |
NPI | 1295346906 |
---|---|
Provider Name | Allen Dolberry |
First Address | Bakersfield, CA 93301-4002 |
Second Address | Newhall, CA 91321-2777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2020 |
Last Update Date | 14/08/2020 |