Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 87056 | CA |
NPI | 1174194021 |
---|---|
Provider Name | Christine Arambulo Pangga |
First Address | Artesia, CA 90701-5713 |
Second Address | Artesia, CA 90701-5713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2021 |
Last Update Date | 01/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87056 | (05) | CA |