Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | ||
N | 126800000X | Dental Assistant |
NPI | 1346849163 |
---|---|
Provider Name | Ambrosia Evon Steljes |
First Address | Camp Pendleton, CA 92055-5221 |
Second Address | Camp Pendleton, CA 92055-5221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2020 |
Last Update Date | 22/10/2020 |