Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 42578 | CA |
NPI | 1023226347 |
---|---|
Provider Name | Dr. Fernando Moises Munguia |
First Address | Upland, CA 91784-2401 |
Second Address | Upland, CA 91784-2401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |