Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA87104 | CA |
NPI | 1073051439 |
---|---|
Provider Name | Mr. Julio Cesar Alonso I |
First Address | Los Angeles, CA 90031-2237 |
Second Address | Los Angeles, CA 90031-2237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 06/02/2017 |