Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | F406 | CA |
NPI | 1316311509 |
---|---|
Provider Name | Jose Joaquin Estalilla Hernandez |
First Address | Bakersfield, CA 93311-9677 |
Second Address | San Francisco, CA 94158-2549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2015 |
Last Update Date | 25/11/2015 |