Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC28449 | CA |
NPI | 1144455965 |
---|---|
Provider Name | Joserodel Zavala Candelario |
First Address | Bonita, CA 91902-1700 |
Second Address | Bonita, CA 91902-1700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2009 |
Last Update Date | 22/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WDC28449 | (02) | CA |