Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC20503 | CA |
NPI | 1003800681 |
---|---|
Provider Name | Mr. Larry Rene Auda |
First Address | Ventura, CA 93003-9078 |
Second Address | Ventura, CA 93003-9078 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 08/07/2007 |