Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC24621 | CA |
NPI | 1144435223 |
---|---|
Provider Name | Dr. Michael S Spearman |
First Address | Los Angeles, CA 90029-1601 |
Second Address | Los Angeles, CA 90029-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 10/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1346406527 | NPI-2 (01) | CA |
75390 | (02) | CA |
DC24621 | MEDICARE ID (PTAN) (01) | CA |