Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1104113778 |
---|---|
Provider Name | Dr. Sheldon Troy Anderson |
First Address | Rancho Cucamonga, CA 91730-4449 |
Second Address | Rancho Cucamonga, CA 91730-4449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 22/10/2013 |