Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 08-5808 | CA |
NPI | 1114225349 |
---|---|
Provider Name | Alma Delia Coronado |
First Address | La Puente, CA 91746-2307 |
Second Address | Riverside, CA 92503-5225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2011 |
Last Update Date | 12/03/2011 |