Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 15661 | CA |
N | 111NN1001X | Nutrition | 15661 | CA |
NPI | 1013207604 |
---|---|
Provider Name | Dr. Martha Dandridge Bordonaro |
First Address | Templeton, CA 93465-5603 |
Second Address | Templeton, CA 93465-5603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2011 |
Last Update Date | 15/04/2011 |