Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | A23044 | CA |
NPI | 1124200381 |
---|---|
Provider Name | Dr. Alfonso P Miguel |
First Address | Glendora, CA 91740-6247 |
Second Address | Glendora, CA 91740-6247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2007 |
Last Update Date | 29/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A230440 | (05) | CA |
A23376 | (02) | CA |