Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC11770 | CA |
NPI | 1689780140 |
---|---|
Provider Name | Dr. Larry Ernest Masula |
First Address | Chico, CA 95973-4932 |
Second Address | Chico, CA 95973-4932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 02/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T04481 | (02) | CA |