Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | CA |
NPI | 1033351150 |
---|---|
Provider Name | Mr. Jonathan Campos |
First Address | Valencia, CA 91355-0986 |
Second Address | Valencia, CA 91355-0986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 03/04/2009 |