Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A43291 | CA |
NPI | 1043323488 |
---|---|
Provider Name | Carlo Amazona |
First Address | Bakersfield, CA 93302-1559 |
Second Address | Mcfarland, CA 93250-1360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B43722 | (02) |