Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 19143 | FL |
N | 122300000X | Dentist | 64478 | CA |
Y | 1223P0221X | Pediatric Dentist | 64478 | CA |
NPI | 1003136649 |
---|---|
Provider Name | Dr. Marian Iskander Manson |
First Address | Valley Center, CA 92082-5338 |
Second Address | Valley Center, CA 92082-5338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2010 |
Last Update Date | 02/08/2017 |