Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 75819 | CA |
NPI | 1003202938 |
---|---|
Provider Name | Christina Cowell |
First Address | Norco, CA 92860-2243 |
Second Address | Noroc, CA 92860 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 07/04/2015 |