Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1811262413 |
---|---|
Provider Name | Antonio Alcorta |
First Address | Fresno, CA 93727-1561 |
Second Address | Stockton, CA 95207-6420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2012 |
Last Update Date | 14/03/2012 |