Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 62632 | CA |
NPI | 1225274400 |
---|---|
Provider Name | Christina M Vidal |
First Address | Fresno, CA 93727 |
Second Address | Clovis, CA 93612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2008 |
Last Update Date | 12/01/2009 |