Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 79011 | CA |
NPI | 1063895712 |
---|---|
Provider Name | Christina Dorantes |
First Address | Rancho Cucamonga, CA 91730-6837 |
Second Address | Rancho Cucamonga, CA 91730-6837 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 30/06/2015 |