Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 64000 | CA |
NPI | 1376786442 |
---|---|
Provider Name | Claudia Climaco |
First Address | Glendale, CA 91207-1968 |
Second Address | Los Angeles, CA 90017-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2009 |
Last Update Date | 19/04/2009 |