Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 12466 | CA |
NPI | 1104906171 |
---|---|
Provider Name | Dr. Raul M. Marco |
First Address | Sun Valley, CA 91352-3301 |
Second Address | Sun Valley, CA 91352-3301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 01/02/2008 |