Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 20A13813 | CA |
Y | 213ES0000X | Sports Medicine | 20A13813 | CA |
NPI | 1487067369 |
---|---|
Provider Name | Neal Washburn |
First Address | Huntington Beach, CA 92648-6097 |
Second Address | Huntington Beach, CA 92648-6097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2014 |
Last Update Date | 16/04/2019 |