Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 138240 | CA |
NPI | 1093150682 |
---|---|
Provider Name | Mr. Carlos Ernesto Aragon |
First Address | South Gate, CA 90280-8172 |
Second Address | South Gate, CA 90280-8172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2013 |
Last Update Date | 08/05/2013 |