Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G69172 | CA |
N | 208600000X | Surgeon | G69172 | CA |
Y | 2082S0105X | Plastic Hand Surgeon | G69172 | CA |
NPI | 1669468872 |
---|---|
Provider Name | Dr. Michael James Fealy |
First Address | Ventura, CA 93003-7844 |
Second Address | Simi Valley, CA 93065-2352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2005 |
Last Update Date | 27/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F16274 | (02) | CA |
F16274 | UPIN (01) | CA |
G69172 | STATE LICENSE (01) | CA |