Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 95002162 | CA |
NPI | 1013301266 |
---|---|
Provider Name | Ronaldo Mamaril |
First Address | Torrance, CA 90505-4737 |
Second Address | Torrance, CA 90505-4737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 24/08/2016 |