Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 54184 | CA |
NPI | 1043368517 |
---|---|
Provider Name | Dr. Marc Pana |
First Address | Huntington Park, CA 90255-4122 |
Second Address | Huntington Park, CA 90255-4122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |