Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 19676 | CA |
NPI | 1417353434 |
---|---|
Provider Name | Dr. Stewart Paul Gesler |
First Address | Stockton, CA 95204-3638 |
Second Address | Stockton, CA 95204-3638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2014 |
Last Update Date | 18/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U40860 | (02) | CA |