Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 36261 | CA |
NPI | 1124464714 |
---|---|
Provider Name | Dr. Gary Ralph Massa |
First Address | Los Angeles, CA 90045-3606 |
Second Address | Los Angeles, CA 90045-3606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2013 |
Last Update Date | 22/05/2013 |