Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1043507437 |
---|---|
Provider Name | Mr. Derek James Augarten |
First Address | San Dimas, CA 91773-3505 |
Second Address | San Dimas, CA 91773-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2011 |
Last Update Date | 09/05/2013 |