Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CA |
NPI | 1962174862 |
---|---|
Provider Name | Rodney Bernice Harrison |
First Address | Rancho Cucamonga, CA 91737-3830 |
Second Address | Rancho Cucamonga, CA 91737-3830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2021 |
Last Update Date | 29/09/2021 |