Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 37509 | CA |
NPI | 1154415230 |
---|---|
Provider Name | Dr. Charles Vincent Tatosian |
First Address | Mission Viejo, CA 92691-5328 |
Second Address | Mission Viejo, CA 92691-5328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |