Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E1620 | CA |
Y | 222Z00000X | Podiatrist | E1620 | CA |
NPI | 1053397802 |
---|---|
Provider Name | Dr. Marc D Spitz, D.p.m. Inc |
First Address | Seal Beach, CA 90740-5503 |
Second Address | Seal Beach, CA 90740-5503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 23/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11011 | (02) |