Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 28822 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A50488 | CA |
NPI | 1558416065 |
---|---|
Provider Name | Dr. Ben F Tarsitano |
First Address | Watsonville, CA 95076-6020 |
Second Address | Watsonville, CA 95076-6020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 11/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A504880 | (05) | CA |
U19243 | (02) | CA |