Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A40164 | CA |
NPI | 1013901552 |
---|---|
Provider Name | Visith Priromprintr |
First Address | Moreno Valley, CA 92557-7907 |
Second Address | Moreno Valley, CA 92557-7907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 15/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A29063 | (02) | |
OOA401640 | (05) | CA |