Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1477584787 |
---|---|
Provider Name | Mr. Sean Leland Stellar |
First Address | Pasadena, CA 91105-3902 |
Second Address | Pasadena, CA 91105-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 22/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XC0001829 | (05) | CA |