Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 101023 | CA |
NPI | 1023554565 |
---|---|
Provider Name | Ruben Espinoza |
First Address | Martinez, CA 94553-4600 |
Second Address | Martinez, CA 94553-4600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2017 |
Last Update Date | 09/01/2017 |