Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | DC19233 | CA |
Y | 225100000X | Physical Therapist | 00PT93850 | CA |
NPI | 1235290461 |
---|---|
Provider Name | Dr. Othman Sami Nihad |
First Address | Stockton, CA 95269-2077 |
Second Address | Stockton, CA 95207-1824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 15/01/2013 |