Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 03938 |
NPI | 1740796754 |
---|---|
Provider Name | Vincent Leonard Reeves |
First Address | National City, CA 91950-6127 |
Second Address | National City, CA 91950-6127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2017 |
Last Update Date | 28/12/2017 |