Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A68291 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A68291 | CA |
NPI | 1346297165 |
---|---|
Provider Name | Dr. Juan Carlos Frisancho |
First Address | Torrance, CA 90505-4039 |
Second Address | Torrance, CA 90505-4039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A68291 | MEDICAL LICENSE (01) | CA |
I00980 | (02) | CA |