Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1376732719 |
---|---|
Provider Name | Vicki Hernandez |
First Address | Stockton, CA 95202-1324 |
Second Address | Stockton, CA 95202-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2007 |
Last Update Date | 22/10/2007 |