Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A25306 | CA |
NPI | 1184772055 |
---|---|
Provider Name | Clifford Thomas Hartman JR. |
First Address | La Canada, CA 91011 |
Second Address | La Canada, CA 91011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 26/09/2018 |