Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 33208 | CA |
NPI | 1003209974 |
---|---|
Provider Name | Dr. Robert Jordan Adams |
First Address | San Jose, CA 95134-1652 |
Second Address | Scotts Valley, CA 95066-3429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2015 |
Last Update Date | 16/04/2015 |