Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 36150 | CA |
NPI | 1033138326 |
---|---|
Provider Name | Dr. Randy William Garland |
First Address | Encinitas, CA 92024-5136 |
Second Address | Encinitas, CA 92024-5136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 08/07/2007 |