Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 21096 | CA |
Y | 111NS0005X | Chiropractic Sports Physician | 21096 | CA |
NPI | 1275852543 |
---|---|
Provider Name | Dr. Alejandro Bolivar Platon |
First Address | Los Angeles, CA 90010-1107 |
Second Address | Los Angeles, CA 90010-1107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2010 |
Last Update Date | 25/05/2010 |