Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 18901 | CA |
NPI | 1508097700 |
---|---|
Provider Name | Percival Magpusao Manzano |
First Address | Vacaville, CA 95687-6345 |
Second Address | Vacaville, CA 95687-6345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 05/08/2009 |