Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 18619 | CA |
NPI | 1215157151 |
---|---|
Provider Name | Dr. Luis Fernando Ruano |
First Address | Thousand Oaks, CA 91362-2816 |
Second Address | Thousand Oaks, CA 91362-2816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |