Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | A56035 | CA |
NPI | 1073558235 |
---|---|
Provider Name | Jorge Thomas Vournas |
First Address | Oklahoma City, OK 73134-1785 |
Second Address | Torrance, CA 90503-4607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 19/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A560350 | (05) | CA |
G67956 | (02) | CA |