Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 55484 | CA |
NPI | 1043671100 |
---|---|
Provider Name | Mr. Rogelio Martin Turner |
First Address | San Diego, CA 92105-2278 |
Second Address | San Diego, CA 92114-6201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2016 |
Last Update Date | 16/03/2016 |