Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 11487 | CA |
N | 175F00000X | Naturopath | 292 | AZ |
NPI | 1063545861 |
---|---|
Provider Name | Dr. Anthony J. Mustaro |
First Address | Santa Rosa, CA 95404-3211 |
Second Address | Santa Rosa, CA 95404-3211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 08/07/2007 |