Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1200X | Ergonomics | PT12318 | CA |
Y | 225XE1200X | Ergonomics | PT12318 | CA |
NPI | 1760403505 |
---|---|
Provider Name | Mr. Scott Ken Salee |
First Address | Antelope, CA 95843-5908 |
Second Address | Folsom, CA 95630-3830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R24545 | (02) | CA |