Provider Demographics
NPI:1578726022
Name:DOTY, SPENCER ARDEN (CPO)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:ARDEN
Last Name:DOTY
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 E CHEVY CHASE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4741
Mailing Address - Country:US
Mailing Address - Phone:818-522-8781
Mailing Address - Fax:
Practice Address - Street 1:1577 E CHEVY CHASE DR STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4741
Practice Address - Country:US
Practice Address - Phone:818-495-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist