Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1104097120 |
---|---|
Provider Name | Mr. Randall L Strong |
First Address | San Diego, CA 92123-3333 |
Second Address | Vista, CA 92083-6004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2008 |
Last Update Date | 18/03/2008 |