Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 24345 | CA |
NPI | 1063657336 |
---|---|
Provider Name | Dr. John Sebastian Sottosanti |
First Address | La Jolla, CA 92037-4528 |
Second Address | La Jolla, CA 92037-4528 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 15/12/2008 |