Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E5695 | CA |
Y | 222Z00000X | Podiatrist | E5695 | CA |
NPI | 1063908853 |
---|---|
Provider Name | Christopher Tatum |
First Address | Oxnard, CA 93036-0649 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2018 |
Last Update Date | 17/09/2021 |