Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 001184 | CA |
Y | 222Z00000X | Podiatrist | 001184 | CA |
N | 224P00000X | Prosthetist | 00184 | CA |
N | 225000000X | Orthotic Fitter | 00184 | CA |
NPI | 1912107012 |
---|---|
Provider Name | Duane Toderan |
First Address | Westlake Village, CA 91362-3626 |
Second Address | Westlake Village, CA 91362-3626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 18/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100637 | STATE OF CALIFORNIA HOME (01) | CA |