Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 29194 | CA |
NPI | 1053869677 |
---|---|
Provider Name | Betzabee Nicolas Gutierrez |
First Address | El Sobrante, CA 94803-1704 |
Second Address | Watsonville, CA 95076-2059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2016 |
Last Update Date | 12/09/2016 |