Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C51263 | CA |
NPI | 1427431824 |
---|---|
Provider Name | Michael Todd |
First Address | Pleasant Hill, CA 94523-4650 |
Second Address | Pleasant Hill, CA 94523-4650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 02/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C51263 | CFO BOARD OF CERIFICATION (01) | CA |