Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 38327 | CA |
NPI | 1114063609 |
---|---|
Provider Name | Dr. Barzin Tom Massarat |
First Address | Bonita, CA 91902-2443 |
Second Address | Bonita, CA 91902-2443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |