Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 62328 | CA |
Y | 1223P0221X | Pediatric Dentist | 62328 | CA |
NPI | 1679868921 |
---|---|
Provider Name | Dr. Nicholas R Jize |
First Address | San Diego, CA 92129-2946 |
Second Address | San Diego, CA 92129-2946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2011 |
Last Update Date | 24/10/2013 |