Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1255528089 |
---|---|
Provider Name | Eve Sepulveda |
First Address | Los Angeles, CA 90073-1003 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2007 |
Last Update Date | 25/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CP2627 | ABC ORTHOTICS PROSTHETIC (01) |