Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | G48510 | CA |
NPI | 1013097534 |
---|---|
Provider Name | Mark B Sender |
First Address | Santa Clarita, CA 91355-9513 |
Second Address | Santa Clarita, CA 91355-9513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 29/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G485100 | (05) | CA |
A51084 | (02) | CA |