Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 61740 | CA |
N | 1223D0001X | Dental Public Health | 61740 | CA |
N | 1223G0001X | General Practice | 61740 | CA |
N | 213EG0000X | General Practice | 61740 | CA |
NPI | 1588007108 |
---|---|
Provider Name | Christine Shehata |
First Address | Montebello, CA 90640 |
Second Address | Montebello, CA 90640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 22/09/2015 |