Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A102560 | CA |
NPI | 1437265980 |
---|---|
Provider Name | Carlo Honrado |
First Address | Los Angeles, CA 90067-2001 |
Second Address | Los Angeles, CA 90067-2001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02578605 | (05) | NY |
H85623 | (02) | NY |