Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1023298205 |
---|---|
Provider Name | Andrew Campbell |
First Address | Oakland, CA 94621-1448 |
Second Address | Oakland, CA 94621-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2007 |
Last Update Date | 06/11/2007 |