Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 88938 | CA |
NPI | 1326528563 |
---|---|
Provider Name | Geremias Aguilar JR. |
First Address | Los Angeles, CA 90031-2076 |
Second Address | Los Angeles, CA 90031-2076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 16/08/2018 |