Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 1331267936 | CA |
NPI | 1306349832 |
---|---|
Provider Name | Brenda Villegas |
First Address | Brea, CA 92821-2753 |
Second Address | Brea, CA 92821-2753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2018 |
Last Update Date | 11/03/2018 |