Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 4480889 | CA |
NPI | 1043446933 |
---|---|
Provider Name | Mr. Jorge Luis Nunez |
First Address | Los Angeles, CA 90058 |
Second Address | Los Angeles, CA 90058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 05/06/2009 |