Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003476 | CA |
NPI | 1033736848 |
---|---|
Provider Name | Sue Sean |
First Address | Los Angeles, CA 90006-3734 |
Second Address | Los Angeles, CA 90006-3734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2020 |
Last Update Date | 26/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CP003476 | ABCOP, (01) | CA |