Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP5207 | CA |
NPI | 1003983875 |
---|---|
Provider Name | Scott Swartz |
First Address | Fontana, CA 92335-6720 |
Second Address | Fontana, CA 92335-6720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 23/09/2008 |