Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC30014 | CA |
N | 111NR0200X | Radiology | RHC 00166643 | CA |
N | 213ER0200X | Radiology | RHC 00166643 | CA |
NPI | 1619107927 |
---|---|
Provider Name | Dr. Delos Soehren JR. |
First Address | La Quinta, CA 92253-7247 |
Second Address | La Quinta, CA 92253-7247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 21/07/2009 |