Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A55611 | CA |
NPI | 1013018373 |
---|---|
Provider Name | Jose Adalberto Dheming |
First Address | Chino, CA 91710 |
Second Address | Chino, CA 91710 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 13/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A556110 | (05) | CA |
G26354 | (02) |