Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A116624 | CA |
NPI | 1003005109 |
---|---|
Provider Name | Dr. Nicholas Aaron Fettman |
First Address | Simi Valley, CA 93065-1530 |
Second Address | Oxnard, CA 93030-3790 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2007 |
Last Update Date | 27/11/2019 |