Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | G45952 | CA |
NPI | 1982715512 |
---|---|
Provider Name | Felizardo S. Camilon JR. |
First Address | Orange, CA 92868-4509 |
Second Address | Orange, CA 92868-4509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 26/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G459520 | (05) | CA |