Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA37294 | CA |
NPI | 1215439468 |
---|---|
Provider Name | Alicia Huizar Quidera |
First Address | Long Beach, CA 90815-2850 |
Second Address | Long Beach, CA 90815-2850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2018 |
Last Update Date | 04/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA37294 | (05) | CA |