Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | C42466 | CA |
NPI | 1609847649 |
---|---|
Provider Name | U.a. Garred Sexton |
First Address | Torrance, CA 90505-2522 |
Second Address | Torrance, CA 90505-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 08/03/2010 |