Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | E3318 | CA |
NPI | 1356478598 |
---|---|
Provider Name | Dr. Walter Stanley Kantor |
First Address | Laguna Hills, CA 92653-1732 |
Second Address | Laguna Hills, CA 92653-1732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E33180 | (05) | CA |
E3318 | 1 (01) | CA |
T11632 | (02) | CA |