Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 92440 | CA |
NPI | 1336782796 |
---|---|
Provider Name | Angelica Lopez |
First Address | Los Angeles, CA 90001-1217 |
Second Address | Los Angeles, CA 90007-2298 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2019 |
Last Update Date | 17/10/2019 |