Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 20916 | CA |
NPI | 1053656553 |
---|---|
Provider Name | Dr. Norman John Nagel |
First Address | Simi Valley, CA 93063-2188 |
Second Address | Simi Valley, CA 93063-2188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2012 |
Last Update Date | 10/12/2012 |