Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 27582 | TX |
N | 122300000X | Dentist | 58762 | CA |
N | 1223D0004X | Dentist Anesthesiologist | 27582 | TX |
Y | 1223D0004X | Dentist Anesthesiologist | 58762 | CA |
NPI | 1669701819 |
---|---|
Provider Name | Dr. Chad Anthony Tomazin |
First Address | Riverside, CA 92506-5483 |
Second Address | Riverside, CA 92506-5483 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2009 |
Last Update Date | 04/03/2014 |