Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA92080 | CA |
NPI | 1215543319 |
---|---|
Provider Name | Chimene Coffey |
First Address | Murrieta, CA 92563-7952 |
Second Address | Menifee, CA 92584-6805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 23/09/2020 |