Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 15691 | CA |
Y | 111NR0400X | Rehabilitation Chiropractor | 15691 | CA |
NPI | 1588748487 |
---|---|
Provider Name | Dr. Dan Ray Spinato |
First Address | San Diego, CA 92129-2159 |
Second Address | San Diego, CA 92129-2159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 05/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T18118 | (02) | CA |