Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 104739 | CA |
NPI | 1063935534 |
---|---|
Provider Name | Dr. Hector M Carmona |
First Address | Montebello, CA 90640-3900 |
Second Address | Montebello, CA 90640-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2017 |
Last Update Date | 26/08/2020 |