Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 34219 | CA |
NPI | 1013573625 |
---|---|
Provider Name | Monvelea Makor |
First Address | San Diego, CA 92117-5333 |
Second Address | Santee, CA 92071-3834 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2019 |
Last Update Date | 20/05/2019 |