Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | C51161 | CA |
NPI | 1326263575 |
---|---|
Provider Name | Dr. Jon Inman Sattler |
First Address | Glendora, CA 91741 |
Second Address | Glendora, CA 91741 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 18/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BS8289349 | DEA NO. (01) | CA |
C51161 | MEDICAL LICENSE (01) | CA |