Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 20A14570 | CA |
NPI | 1053723064 |
---|---|
Provider Name | Joseph Collins |
First Address | Westlake Village, CA 91362-3816 |
Second Address | Westlake Village, CA 91362-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2014 |
Last Update Date | 06/01/2020 |