Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 24184 | CA |
Y | 213EG0000X | General Practice | 24184 | CA |
NPI | 1003069568 |
---|---|
Provider Name | Dr. Daniel Tevrizian |
First Address | San Marcos, CA 92069-2934 |
Second Address | San Marcos, CA 92069-2934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2008 |
Last Update Date | 28/10/2008 |