Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC15810 | CA |
Y | 213ER0200X | Radiology | DC15810 | CA |
NPI | 1407998172 |
---|---|
Provider Name | Cameron Grade |
First Address | Saugus, CA 91350-2670 |
Second Address | Saugus, CA 91350-2670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 23/02/2012 |