Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | C393410 | CA |
NPI | 1043317993 |
---|---|
Provider Name | Mr. Carl V Greek |
First Address | Corona, CA 92879-3332 |
Second Address | Corona, CA 92879-3332 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 03/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C393410 | (05) | CA |
A37117 | (02) |