Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1073136982 |
---|---|
Provider Name | Daniel Pere |
First Address | Orangevale, CA 95662-4791 |
Second Address | Orangevale, CA 95662-4791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2020 |
Last Update Date | 26/05/2020 |