Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP001228 | DE |
NPI | 1316134802 |
---|---|
Provider Name | Suzanne Mary Eckhardt |
First Address | Los Angeles, CA 90017-1912 |
Second Address | Los Angeles, CA 90017-1912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2007 |
Last Update Date | 27/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GFC000250 | (05) | CA |