Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2-37655 | CA |
NPI | 1144352766 |
---|---|
Provider Name | Dr. John P. Endow |
First Address | Camarillo, CA 93010-5914 |
Second Address | Camarillo, CA 93010-5914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
850412 & 781138 | UNITED CONCORDIA (01) | CA |