Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1013329093 |
---|---|
Provider Name | Ana Martinez |
First Address | Sun Valley, CA 91352-3969 |
Second Address | Sun Valley, CA 91352-3969 |
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 |