Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | E4526 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E4526 | CA |
NPI | 1255366779 |
---|---|
Provider Name | Dr. Edwin Oghoorian |
First Address | Glendora, CA 91741-4205 |
Second Address | Glendora, CA 91741-4205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 15/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E45260 | (05) | CA |
V00838 | (02) |