Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 65165 | CA |
NPI | 1235374588 |
---|---|
Provider Name | Bladimir A Martinez |
First Address | North Hills, CA 91343 |
Second Address | North Hills, CA 91343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 15/12/2008 |