Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CF0O3556 |
NPI | 1467857581 |
---|---|
Provider Name | Justin Crandell |
First Address | Sacramento, CA 95816-5225 |
Second Address | Sacramento, CA 95816-5225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2014 |
Last Update Date | 31/10/2014 |