Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | A28689 | CA |
Y | 208D00000X | General Practice Physician | A28689 | CA |
NPI | 1417367079 |
---|---|
Provider Name | Mark S. Bettermon |
First Address | Camarillo, CA 93012 |
Second Address | Camarillo, CA 93012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2014 |
Last Update Date | 05/05/2014 |