Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | C042356 | CA |
NPI | 1093894941 |
---|---|
Provider Name | Dr. Freddie Dial |
First Address | Riverside, CA 92503-3901 |
Second Address | Riverside, CA 92503-3901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C423560 | (05) | CA |
B29217 | (02) | CA |