Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 2875 | CA |
NPI | 1164664264 |
---|---|
Provider Name | Jonathan J Pichardo |
First Address | Long Beach, CA 90810-2217 |
Second Address | Torrance, CA 90505-2408 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 03/04/2009 |