Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A112615 | CA |
NPI | 1679784664 |
---|---|
Provider Name | Dr. Michael Bublik |
First Address | Glendale, CA 91204-4388 |
Second Address | Glendale, CA 91204-4388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 26/02/2020 |