Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225C00000X | Rehabilitation Counselor |
NPI | 1013081512 |
---|---|
Provider Name | Mr. Paul Anthony Prusak |
First Address | Oroville, CA 95966 |
Second Address | Oroville, CA 95965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 08/07/2007 |