Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC 25528 | CA |
Y | 213ER0200X | Radiology | DC 25528 | CA |
NPI | 1649468620 |
---|---|
Provider Name | Jason David Vanderford |
First Address | Carlsbad, CA 92009-4556 |
Second Address | Westlake Village, CA 91361-2697 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 07/01/2014 |