Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC28996 | CA |
NPI | 1023031895 |
---|---|
Provider Name | Dr. Kenneth W Pierce |
First Address | Temecula, CA 92590-2856 |
Second Address | Temecula, CA 92590-2856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |