Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A100020 | CA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | A100020 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A100020 | CA |
NPI | 1750590188 |
---|---|
Provider Name | Gregory J Vipond |
First Address | Claremont, CA 91711-2962 |
Second Address | Claremont, CA 91711-2962 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 04/09/2014 |