Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A70815 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A70815 | CA |
NPI | 1083645360 |
---|---|
Provider Name | Mark L Schamblin |
First Address | Van Nuys, CA 91405-3796 |
Second Address | Van Nuys, CA 91405-3796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 16/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H91822 | (02) | CA |
P00249615 | RRMCR (01) | CA |