Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC26418 | CA |
NPI | 1952524001 |
---|---|
Provider Name | Dr. Datis Kharrazian |
First Address | Encinitas, CA 92024-3748 |
Second Address | Encinitas, CA 92024-3748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |