Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | A047889 | CA |
Y | 2081P2900X | Pain Medicine | A047889 | CA |
NPI | 1275633232 |
---|---|
Provider Name | Philip J Citek |
First Address | San Luis Obispo, CA 93403-4609 |
Second Address | Atascadero, CA 93422-4433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 03/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E17681 | (02) |