Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 40392 | CA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A72867 | CA |
NPI | 1538492707 |
---|---|
Provider Name | Voltaire Sambajon |
First Address | Folsom, CA 95630-3556 |
Second Address | Folsom, CA 95630-3556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2009 |
Last Update Date | 06/09/2009 |