Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC 28481 | CA |
NPI | 1497946826 |
---|---|
Provider Name | Chris John Fiorentiro |
First Address | Santa Ana, CA 92705-7867 |
Second Address | Santa Ana, CA 92705-7867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 02/03/2009 |