Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | CAG040474 | CA |
NPI | 1164409116 |
---|---|
Provider Name | Dr. Charles Macaulay Hott |
First Address | Willits, CA 95490-4225 |
Second Address | Willits, CA 95490-4225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C99661 | (02) | CA |