Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A122221 | CA |
NPI | 1205193521 |
---|---|
Provider Name | Dr. Noel Nepomuceno JR. |
First Address | Loma Linda, CA 92354-6545 |
Second Address | Wildomar, CA 92595-9583 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2012 |
Last Update Date | 01/12/2021 |