Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 65013 | CA |
NPI | 1003283581 |
---|---|
Provider Name | Clara Anisel Mendez Baez |
First Address | Salida, CA 95368-9313 |
Second Address | Salida, CA 95368-9313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2015 |
Last Update Date | 07/01/2019 |