Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CPO-02611 | VA |
NPI | 1902841356 |
---|---|
Provider Name | Rakesh K Srivastava |
First Address | Hastings, NE 68901-7383 |
Second Address | Hastings, NE 68901-3200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 08/05/2008 |