Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHOOO3154 | FL |
NPI | 1053304683 |
---|---|
Provider Name | Dr. Louis Scoma |
First Address | Cape Coral, FL 33904-7141 |
Second Address | Cape Coral, FL 33904-7141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T93981 | (02) | FL |