Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | CA | |
N | 126800000X | Dental Assistant | RDA87790 | CA |
NPI | 1336636869 |
---|---|
Provider Name | Cynthia Lynn Ford |
First Address | Loma Linda, CA 92354-3144 |
Second Address | Loma Linda, CA 92354-3144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2018 |
Last Update Date | 19/04/2018 |