Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | GFE16642 | CA |
NPI | 1013246578 |
---|---|
Provider Name | Dr. John Joseph Dimare JR. |
First Address | Glendora, CA 91741-4218 |
Second Address | Glendora, CA 91741-4218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2009 |
Last Update Date | 12/12/2009 |