Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 85533 | CA |
NPI | 1245730407 |
---|---|
Provider Name | Angelica Perez |
First Address | Long Beach, CA 90806-5247 |
Second Address | Torrance, CA 90501-6901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2018 |
Last Update Date | 14/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85533 | (05) | CA |