Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC 20074 | CA |
NPI | 1083647051 |
---|---|
Provider Name | Andre Marcel Acebo |
First Address | Santa Maria, CA 93458-7310 |
Second Address | Templeton, CA 93465-4003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 18/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FHC70936F | TEMPLETON M/CAL # (01) | CA |
W1508 | MEDICARE GROUP NUMBER (01) | CA |
W1508A | CHCCC, TEMPLETON MEDICARE GROUP # (01) | CA |