Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 25020 | CA |
NPI | 1275640005 |
---|---|
Provider Name | Dr. Michael K Mountain |
First Address | San Diego, CA 92108-1313 |
Second Address | San Diego, CA 92108-1313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 19/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U69770 | (02) | CA |