Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2269 | CA |
Y | 222Z00000X | Podiatrist | E2269 | CA |
NPI | 1043282825 |
---|---|
Provider Name | Dr. Robert John Scagliola |
First Address | Burlingame, CA 94010 |
Second Address | Burlingame, CA 94010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E22690 | (05) | CA |
AS8375164 | DEA (01) | |
T11250 | (02) |