Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP004467 | CA |
NPI | 1376217141 |
---|---|
Provider Name | Mackinley Spencer Burrell |
First Address | Santa Ana, CA 92701-5002 |
Second Address | Santa Ana, CA 92701-5002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 05/08/2021 |