Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | PA56123 | CA |
NPI | 1225504301 |
---|---|
Provider Name | Amgad Alfred |
First Address | Rancho Cucamonga, CA 91739-8842 |
Second Address | Apple Valley, CA 92307-2210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2018 |
Last Update Date | 16/10/2018 |