Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 71506 | CA |
NPI | 1215350129 |
---|---|
Provider Name | Darline Torres |
First Address | Garden Grove, CA 92840-3146 |
Second Address | Garden Grove, CA 92840-3146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2014 |
Last Update Date | 28/01/2014 |