Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1013417393 |
---|---|
Provider Name | Mr. Justin Michael Tegerstrand |
First Address | Redding, CA 96001-2704 |
Second Address | Redding, CA 96001-2704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2018 |
Last Update Date | 30/06/2021 |