Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 27028 | CA |
NPI | 1316167273 |
---|---|
Provider Name | Dr. John Charles Luomanen |
First Address | San Diego, CA 92130-2742 |
Second Address | San Diego, CA 92130-2742 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 16/02/2012 |