Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 15636 | CA |
NPI | 1730399817 |
---|---|
Provider Name | Leslie Julian Prins |
First Address | Alameda, CA 94501-3022 |
Second Address | Alameda, CA 94501-4514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T05861 | (02) | CA |