Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C52814 | CA |
NPI | 1598225807 |
---|---|
Provider Name | Nicholas Degabriele |
First Address | Sacramento, CA 95821-2123 |
Second Address | Sacramento, CA 95821-2123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2019 |
Last Update Date | 22/03/2019 |