Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 44261 | CA |
NPI | 1013150648 |
---|---|
Provider Name | Dr. Garo Sirinian JR. |
First Address | Solana Beach, CA 92075 |
Second Address | Solana Beach, CA 92075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2009 |
Last Update Date | 20/02/2015 |