Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | G39094 | CA |
N | 2084N0600X | Clinical Neurophysiologist | G39094 | CA |
NPI | 1215962535 |
---|---|
Provider Name | Daniel Alan Shewmon |
First Address | Sylmar, CA 91342-1495 |
Second Address | Sylmar, CA 91342-1495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A92048 | (02) |