Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 27392 | CA |
NPI | 1023356367 |
---|---|
Provider Name | Oscar E Valenzuela |
First Address | Cerritos, CA 90703-2679 |
Second Address | Cerritos, CA 90703-2679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2013 |
Last Update Date | 22/01/2013 |