Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 64229 | CA |
NPI | 1134426521 |
---|---|
Provider Name | Dr. Joseph Mounir Morcos |
First Address | Glendale, CA 91202-2008 |
Second Address | Glendale, CA 91202-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2011 |
Last Update Date | 17/12/2014 |