Individual
AMADO MARAYAG RETUYA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4605 THORNBUSH DR, HEMET, CA 92545-8093
(951) 391-3869
Mailing address
4605 THORNBUSH DR, HEMET, CA 92545-8093
(951) 391-3869
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-1565563
—
CA
Enumeration date
08/19/2021
Last updated
08/19/2021
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