Provider Demographics
NPI:1598094492
Name:JUMIQUE, CESAR SALVADOR (RDA)
Entity Type:Individual
Prefix:MR
First Name:CESAR
Middle Name:SALVADOR
Last Name:JUMIQUE
Suffix:
Gender:M
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 LA SALLE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1161
Mailing Address - Country:US
Mailing Address - Phone:323-236-8547
Mailing Address - Fax:
Practice Address - Street 1:3910 LA SALLE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1161
Practice Address - Country:US
Practice Address - Phone:323-236-8547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55019126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant