1992873327

Everything you always wanted to know about ONTIVEROS DAVID DO but were afraid to ask.

ONTIVEROS DAVID DO

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Provider Last Name Provider First Name Provider Credential
ONTIVEROS DAVID DO
Gender:
Male
Enumeration date:
2006-12-01
Last update date:
2007-07-08
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state

Taxonomies

Taxonomy State License Number Primary?
207Q00000X Family Medicine ID O210 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 2086776428
Practice Location Address Telephone Number 2086776428

Addresses

Type Address City State Postal Country
Mailing Address 1501 HILAND AVE BURLEY ID 83318 ID
Practice Location Address 1501 HILAND AVE BURLEY ID 83318 ID

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