Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A65850 | CA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A65850 | CA |
NPI | 1487702353 |
---|---|
Provider Name | James M Fait |
First Address | Chula Vista, CA 91914 |
Second Address | Temecula, CA 92590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 28/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A65850 | LICENSE (01) | CA |