Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1083801583 |
---|---|
Provider Name | Mr. Chris Leventis |
First Address | Oceanside, CA 92056-2669 |
Second Address | Oceanside, CA 92056-2669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2007 |
Last Update Date | 19/09/2019 |