Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 60652 | CA |
NPI | 1356586739 |
---|---|
Provider Name | Alejandro Parra II |
First Address | San Ysidro, CA 92173-3003 |
Second Address | San Ysidro, CA 92173-3003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2008 |
Last Update Date | 12/12/2008 |