Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003370 | CA |
NPI | 1245492701 |
---|---|
Provider Name | Clint Jonutz |
First Address | Sacramento, CA 95821-2689 |
Second Address | Sacramento, CA 95821-2689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 26/06/2008 |