Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | G19909 | CA |
NPI | 1003114059 |
---|---|
Provider Name | Dr. Richard Nevin Selby |
First Address | Laguna Niguel, CA 92677-4660 |
Second Address | Laguna Niguel, CA 92677-4660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2011 |
Last Update Date | 07/08/2013 |