Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1396374054 |
---|---|
Provider Name | Mark A Amparo |
First Address | San Diego, CA 92193-9043 |
Second Address | San Diego, CA 92117-6953 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2020 |
Last Update Date | 05/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
91202202F80050 | (05) | CA |