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JOSE REAL CATAYOC PONCIANO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LVN

Contact information

Practice address
3580 WILSHIRE BLVD STE 1000, LOS ANGELES, CA 90010-2544
(213) 296-3783
Mailing address
9274 JUNEBERRY LN, NORTH HILLS, CA 91343-7821

Taxonomy

Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
239121
CA

Other

Enumeration date
03/30/2020
Last updated
03/30/2020
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