Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 488 | CA |
NPI | 1083075089 |
---|---|
Provider Name | Mr. Justin Rodriguez Urbano |
First Address | Camarillo, CA 93012 |
Second Address | Camarillo, CA 93012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2016 |
Last Update Date | 18/03/2016 |