Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 81293 | CA |
NPI | 1114531423 |
---|---|
Provider Name | Adriana Vanessa Martinez |
First Address | North Hills, CA 91343-2234 |
Second Address | North Hills, CA 91343-2234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 03/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
81293 | (05) | CA |