Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1518116730 |
---|---|
Provider Name | Mr. Henriquez Delacruz |
First Address | San Diego, CA 92161 |
Second Address | San Diego, CA 92161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2008 |
Last Update Date | 11/09/2008 |