Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | E4144 | CA |
Y | 213ES0000X | Sports Medicine | E4144 | CA |
NPI | 1518003243 |
---|---|
Provider Name | Dale Sovak |
First Address | Benicia, CA 94510-1046 |
Second Address | Benicia, CA 94510-1046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 28/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U71138 | (02) | CA |