Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 26115 | CA |
NPI | 1023420924 |
---|---|
Provider Name | Aimee Victoria |
First Address | Hanford, CA 93230-1286 |
Second Address | Clovis, CA 93611-6813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 27/05/2014 |