Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 177414 | CA |
NPI | 1104384502 |
---|---|
Provider Name | Steven Sousa |
First Address | Eureka, CA 95501-0129 |
Second Address | Eureka, CA 95501-0129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2019 |
Last Update Date | 05/03/2019 |