Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 056889-1 | NY |
Y | 1223P0300X | Periodontist | DDS101038 | CA |
NPI | 1073935128 |
---|---|
Provider Name | Dr. Micael Hilario |
First Address | Torrance, CA 90501-3189 |
Second Address | Torrance, CA 90501-3189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2014 |
Last Update Date | 31/01/2020 |