Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 30965 | CA |
N | 126800000X | Dental Assistant | 70539 | CA |
NPI | 1356588990 |
---|---|
Provider Name | Mr. Xaver Bondoc Pangilinan |
First Address | Whittier, CA 90603-2597 |
Second Address | Los Angeles, CA 90001-1771 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 17/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30965 | DHCC (01) | CA |
70539 | RDA LICENSE (01) | CA |