Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC 17677 | CA |
NPI | 1093871410 |
---|---|
Provider Name | Linda Enemark |
First Address | Bakersfield, CA 93309-0679 |
Second Address | Bakersfield, CA 93309-0679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U02782 | (02) | CA |