Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156F00000X | Technician/Technologist | PTGL296 | CA |
NPI | 1104493485 |
---|---|
Provider Name | Miguel Negrete |
First Address | San Diego, CA 92131-1634 |
Second Address | San Diego, CA 92131-1634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2021 |
Last Update Date | 25/08/2021 |