Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 19778 | CA |
NPI | 1417316761 |
---|---|
Provider Name | Dr. Stephen David Florez |
First Address | Bassett, CA 91746-2524 |
Second Address | Costa Mesa, CA 92627-5196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2016 |
Last Update Date | 18/02/2016 |