Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 84843 | CA |
NPI | 1215476668 |
---|---|
Provider Name | Claudia Contreras |
First Address | Valencia, CA 91355-0986 |
Second Address | Valencia, CA 91355-0986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2017 |
Last Update Date | 17/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
84843 | (05) | CA |