Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 86327 | CA |
NPI | 1023537578 |
---|---|
Provider Name | Isaiah Rene Nuno |
First Address | Pasadena, CA 91103-2936 |
Second Address | Los Angeles, CA 90042-4227 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2017 |
Last Update Date | 15/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86327 | (05) | CA |