Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E3561 | CA |
NPI | 1598812786 |
---|---|
Provider Name | Joel A Ammons III |
First Address | Culver City, CA 90232-1274 |
Second Address | Inglewood, CA 90301-4502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 17/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5537360001 | MEDICARE DME (01) | CA |
E3561 | LICENSE NUMBER (01) | CA |
OOOE35610 | (05) | CA |
T86392 | (02) | CA |