Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DD5229 | NM |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 53926 | CA |
NPI | 1588636310 |
---|---|
Provider Name | Dr. Max Paul Moncayo |
First Address | Pacific Palisades, CA 90272-3940 |
Second Address | Pacific Palisades, CA 90272-3743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 14/11/2019 |