Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC21676 | CA |
NPI | 1265571921 |
---|---|
Provider Name | Dr. Timothy J Esposito SR. |
First Address | Rancho Palos Verdes, CA 90275-1008 |
Second Address | Lomita, CA 90717-1906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DC0216760 | CHIROPRACTIC (01) | CA |
U35238 | (02) | CA |