Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | A62786 | CA |
Y | 207RH0002X | Hospice and Palliative Medicine | A62786 | CA |
NPI | 1205869807 |
---|---|
Provider Name | Nicholas John Jauregui |
First Address | Sierra Madre, CA 91024-2434 |
Second Address | Sierra Madre, CA 91024-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 10/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G75174 | (02) | CA |