Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 70581 | CA |
NPI | 1265070106 |
---|---|
Provider Name | Adrina Lange-Gomez |
First Address | Huntington Beach, CA 92647-7341 |
Second Address | Buena Park, CA 90620-3271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2019 |
Last Update Date | 11/12/2019 |