Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 25691 | CA |
NPI | 1124365580 |
---|---|
Provider Name | Michael Cobin |
First Address | Westlake Village, CA 91362-3692 |
Second Address | Westlake Village, CA 91362-3692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2013 |
Last Update Date | 04/01/2013 |