Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC15026 | CA |
NPI | 1083743520 |
---|---|
Provider Name | Mr. Calvin Belnap Ross |
First Address | San Juan Capistrano, CA 92675 |
Second Address | San Juan Capistrano, CA 92675-3225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 29/02/2008 |