Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | G86400 | CA |
NPI | 1033175922 |
---|---|
Provider Name | John Robert Debanto |
First Address | Bakersfield, CA 93311-3653 |
Second Address | Los Angeles, CA 90026-5494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 27/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10331756922 | (05) | CA |
G03922 | (02) |