Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CP1389 | CA |
N | 222Z00000X | Podiatrist | CP1389 | CA |
N | 224P00000X | Prosthetist | CP1386 | CA |
N | 225000000X | Orthotic Fitter | CP1389 | CA |
NPI | 1952314528 |
---|---|
Provider Name | Mr. Richard Dennis Fite |
First Address | Forest Falls, CA 92339-9698 |
Second Address | Loma Linda, CA 92357-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CP1389 | ABC (01) | CA |