Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 11026 | CA |
NPI | 1528400017 |
---|---|
Provider Name | Dr. Pedro A Ruggiero |
First Address | Los Angeles, CA 90029-1701 |
Second Address | Los Angeles, CA 90029-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2013 |
Last Update Date | 24/07/2013 |