Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 84016 | CA |
NPI | 1356954564 |
---|---|
Provider Name | Berenice Morales |
First Address | Anaheim, CA 92805-5432 |
Second Address | Buena Park, CA 90620-3271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2020 |
Last Update Date | 26/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
84016 | (05) | CA |