Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D3425 | CA |
NPI | 1033260203 |
---|---|
Provider Name | Mr. Alan Leo Liberman |
First Address | Desert Hot Springs, CA 92240-6873 |
Second Address | Desert Hot Springs, CA 92240-6873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DX003425F | (05) | CA |