Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 12754 | CA |
NPI | 1205991213 |
---|---|
Provider Name | Dr. John Maher |
First Address | Valley Center, CA 92082-5256 |
Second Address | Valley Center, CA 92082-6554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 13/04/2015 |