Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC23343 | CA |
NPI | 1104076421 |
---|---|
Provider Name | Dr. Terry T Ogino |
First Address | Costa Mesa, CA 92626-4509 |
Second Address | Costa Mesa, CA 92626-4509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 23/09/2008 |