Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A94941 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A94941 | CA |
NPI | 1114114238 |
---|---|
Provider Name | Dr. Clinton John Soppe |
First Address | Santa Monica, CA 90404-2023 |
Second Address | Torrance, CA 90502-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 04/11/2021 |