Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2090 | CA |
Y | 222Z00000X | Podiatrist | E2090 | CA |
NPI | 1053427971 |
---|---|
Provider Name | Dr. Thomas Anthony Carine |
First Address | San Jose, CA 95128 |
Second Address | San Jose, CA 95128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11172 | (02) |