Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OP60199411 | WA |
Y | 207Q00000X | Family Doctor | OP60199411 | WA |
NPI | 1053554154 |
---|---|
Provider Name | Jeremy A Ginoza |
First Address | Mount Vernon, WA 98274-4127 |
Second Address | Bellingham, WA 98226-8037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2009 |
Last Update Date | 27/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2030502 | (05) | WA |