Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A79166 | CA |
Y | 208600000X | Surgeon | A79166 | CA |
N | 2086S0129X | Vascular Surgeon | A79166 | CA |
NPI | 1174630016 |
---|---|
Provider Name | Milton Retamozo |
First Address | Colton, CA 92324-1801 |
Second Address | Colton, CA 92324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 10/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0079700 | (05) | CA |
I57641 | (02) | CA |