Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | G36771 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | G36771 | CA |
NPI | 1710287594 |
---|---|
Provider Name | Robert Mraule |
First Address | Monterey, CA 93940 |
Second Address | Monterey, CA 93940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2010 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46797 | (02) | CA |