Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 63120 | CA |
NPI | 1053324772 |
---|---|
Provider Name | Dr. Justin Nathanael Naylor |
First Address | San Diego, CA 92130-3061 |
Second Address | San Diego, CA 92130-3061 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 03/12/2021 |