Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC 21182 | CA |
NPI | 1750319901 |
---|---|
Provider Name | Dr. Jess J. Soria III |
First Address | Cerritos, CA 90703-6630 |
Second Address | Cerritos, CA 90703-6630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 28/01/2016 |