Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 51294 | CA |
NPI | 1134306277 |
---|---|
Provider Name | Dr. Manouchehr Pouresmail |
First Address | Bakersfield, CA 93312-5794 |
Second Address | Paso Robles, CA 93446-3754 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2008 |
Last Update Date | 26/08/2010 |