Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | RFOM0053 | DE |
N | 222Z00000X | Podiatrist | RFOM0053 | DE |
N | 224P00000X | Prosthetist | RFOM0053 | DE |
N | 225000000X | Orthotic Fitter | RFOM0053 | DE |
NPI | 1871660050 |
---|---|
Provider Name | Mr. Larry Radford I |
First Address | Gardena, CA 90247 |
Second Address | Los Angeles, CA 90073-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |