Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 22334 | CA |
NPI | 1033612197 |
---|---|
Provider Name | Ian Fitz-Gibbon |
First Address | Newport Beach, CA 92660-3510 |
Second Address | Vernon, CA 90058-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2018 |
Last Update Date | 15/03/2018 |