Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 50433 | CA |
Y | 213EG0000X | General Practice | 50433 | CA |
NPI | 1003022906 |
---|---|
Provider Name | Dr. Barbara Tuazon Amog |
First Address | Murrieta, CA 92563-8341 |
Second Address | Murrieta, CA 92563-8341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50433 | DENTAL LICENSE NUMBER (01) | CA |