Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E3305 | CA |
Y | 222Z00000X | Podiatrist | E3305 | CA |
NPI | 1013960806 |
---|---|
Provider Name | Mr. Anthony Poggio |
First Address | Alameda, CA 94501-4379 |
Second Address | Alameda, CA 94501-4379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 09/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11624 | (02) | CA |