Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 16005 | CA |
NPI | 1013022185 |
---|---|
Provider Name | Dale Michael Migliaccio |
First Address | Santa Barbara, CA 93105-3185 |
Second Address | Santa Barbara, CA 93105-3185 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |