Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 10961 | CA |
Y | 213ES0000X | Sports Medicine | 10961 | CA |
NPI | 1548783855 |
---|---|
Provider Name | Mr. Alex Zutner |
First Address | San Francisco, CA 94116-2632 |
Second Address | Palmdale, CA 93551-4483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2017 |
Last Update Date | 18/07/2017 |