Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3630 | CA |
Y | 222Z00000X | Podiatrist | E3630 | CA |
NPI | 1043316748 |
---|---|
Provider Name | Bill J. Releford |
First Address | Inglewood, CA 90301-2354 |
Second Address | Inglewood, CA 90301-2354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E36300 | (02) | CA |