Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1174760193 |
---|---|
Provider Name | Daisy Gomez |
First Address | Los Angeles, CA 90031-3356 |
Second Address | Los Angeles, CA 90007-2298 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2009 |
Last Update Date | 13/01/2009 |