Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 24669 | CA |
NPI | 1003973470 |
---|---|
Provider Name | Isamel Paul Yturralde |
First Address | Brawley, CA 92227-2737 |
Second Address | Brawley, CA 92227-2737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 21/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
24699 | LICENSE (01) | CA |