Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | C30674 | CA |
NPI | 1467560466 |
---|---|
Provider Name | Dr. Harry Mittelman |
First Address | Los Altos, CA 94024-5428 |
Second Address | Los Altos, CA 94024-5428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A34323 | (02) | CA |