Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 13667 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 13667 | CA |
NPI | 1497866768 |
---|---|
Provider Name | Dr. Michael R Sardone |
First Address | San Diego, CA 92130-6650 |
Second Address | Del Mar, CA 92014-3860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 26/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T17569 | (02) | CA |