Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 22 | CA |
NPI | 1003972233 |
---|---|
Provider Name | Brenda Kibbler |
First Address | Northridge, CA 91326-3047 |
Second Address | Northridge, CA 91326-3047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2006 |
Last Update Date | 08/07/2007 |