Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 34931 | CA |
NPI | 1053534180 |
---|---|
Provider Name | Dr. Rick J. Berrios |
First Address | Huntington Beach, CA 92648-1707 |
Second Address | Huntington Beach, CA 92648-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |