Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 21514 | CA |
NPI | 1174661334 |
---|---|
Provider Name | Dr. Albern Lee Spoolstra |
First Address | Long Beach, CA 90815-1129 |
Second Address | Long Beach, CA 90815-1129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 08/07/2007 |