Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO 955 | |
N | 222Z00000X | Podiatrist | CPO 955 | |
Y | 224P00000X | Prosthetist | CPO 955 |
NPI | 1063690238 |
---|---|
Provider Name | Robert A Jensen |
First Address | Oakland, CA 94609-1310 |
Second Address | Oakland, CA 94609-1310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2008 |
Last Update Date | 24/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CPO 955 | ABC (01) |