Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | G45363 | CA |
NPI | 1255760633 |
---|---|
Provider Name | Steven William Marles |
First Address | Turlock, CA 95382-7448 |
Second Address | Turlock, CA 95382-7448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 05/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A-50000 | (02) | CA |