Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO03339 | |
N | 222Z00000X | Podiatrist | CPO03339 | |
Y | 224P00000X | Prosthetist | CPO03339 |
NPI | 1336625896 |
---|---|
Provider Name | Mr. Michael Lewis Cope |
First Address | Temecula, CA 92591-5285 |
Second Address | Riverside, CA 92506-3807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2018 |
Last Update Date | 17/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CPO03339 | AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS AND PEDORTHICS (01) |