Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | D 7230 | CA |
NPI | 1063603710 |
---|---|
Provider Name | Mr. Manuel Acevedo |
First Address | Sanger, CA 93657-4109 |
Second Address | Sanger, CA 93657-2417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2007 |
Last Update Date | 09/08/2007 |