Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 63666 | CA |
Y | 1223D0001X | Dental Public Health | 63666 | CA |
N | 1223G0001X | General Practice | 63666 | CA |
N | 213EG0000X | General Practice | 63666 | CA |
NPI | 1144637661 |
---|---|
Provider Name | Dr. Nathan James Simarro |
First Address | Ventura, CA 93001-4407 |
Second Address | Ventura, CA 93004-1377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2014 |
Last Update Date | 16/07/2014 |