Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 7143 | CA |
NPI | 1194749366 |
---|---|
Provider Name | Mr. Eric Charles Giddings |
First Address | San Marcos, CA 92078 |
Second Address | San Marcos, CA 92078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100511763 | (05) | CA |