Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | NP11409 | CA |
Y | 363L00000X | Nurse Practitioner | 432043 | CA |
N | 363LX0106X | Nurse Practitioner - Occupational Health | 432043 | CA |
NPI | 1780667360 |
---|---|
Provider Name | Mr. Joel Paul Bresolin |
First Address | Sacramento, CA 95825 |
Second Address | Sacramento, CA 95825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2005 |
Last Update Date | 23/02/2017 |