Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 17841 | CA |
NPI | 1063738482 |
---|---|
Provider Name | Mr. Stan Czerwinski |
First Address | Camarillo, CA 93010-6338 |
Second Address | Camarillo, CA 93010-6338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 09/04/2010 |