Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A83117 | CA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | A83117 | CA |
NPI | 1245411180 |
---|---|
Provider Name | Dr. Eric R Hentzen |
First Address | San Diego, CA 92193-2410 |
Second Address | San Diego, CA 92103-9000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2007 |
Last Update Date | 07/01/2020 |