Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 42311 | CA |
NPI | 1013246024 |
---|---|
Provider Name | Dr. Scott Alexander Fishman |
First Address | Downey, CA 90240-4408 |
Second Address | Downey, CA 90240-4408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2009 |
Last Update Date | 22/12/2009 |