Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | ||
N | 225CA2400X | Assistive Technology Practitioner |
NPI | 1649592338 |
---|---|
Provider Name | Mr. Michael David Foust |
First Address | Moreno Valley, CA 92553-3364 |
Second Address | Moreno Valley, CA 92553-3364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2010 |
Last Update Date | 26/02/2010 |