Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC17526 | CA |
NPI | 1699984195 |
---|---|
Provider Name | Dr. Dale Norris Mortenson |
First Address | San Francisco, CA 94109-2549 |
Second Address | San Francisco, CA 94109-2549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |