Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 10987T | CA |
NPI | 1346294584 |
---|---|
Provider Name | Dr. Jay Michael Mashouf |
First Address | San Diego, CA 92131-3963 |
Second Address | San Diego, CA 92131-3963 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U90110 | (02) | CA |