Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | PA56597 | CA |
NPI | 1265999312 |
---|---|
Provider Name | Stephen Cabalatungan |
First Address | Carson, CA 90745-1522 |
Second Address | Glendale, CA 91204-4388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2019 |
Last Update Date | 25/02/2019 |