Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 33829 | CA |
NPI | 1043681729 |
---|---|
Provider Name | Blanca Gama |
First Address | Torrance, CA 90503-4409 |
Second Address | Torrance, CA 90503-4409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2015 |
Last Update Date | 07/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33289 | DENTAL LICENSE (01) | CA |