Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1114175890 |
---|---|
Provider Name | Mr. Brett B Shuttleworth |
First Address | San Diego, CA 92102-4550 |
Second Address | San Diego, CA 92102-4550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2008 |
Last Update Date | 18/03/2011 |