Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC16404 | CA |
NPI | 1336392133 |
---|---|
Provider Name | Gregory Harvey |
First Address | Cardiff, CA 92007-7176 |
Second Address | San Diego, CA 92121-4710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2008 |
Last Update Date | 24/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CHIRO LICENSE | DC16404 (01) | CA |