Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 52543 | CA |
NPI | 1093927386 |
---|---|
Provider Name | Aeshna Mathur |
First Address | Fontana, CA 92335-4776 |
Second Address | Montebello, CA 90640-3722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 02/05/2016 |