Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 69896 | CA |
NPI | 1326286782 |
---|---|
Provider Name | Debora Cordova |
First Address | Arcadia, CA 91006-3776 |
Second Address | Arcadia, CA 91006-3776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2009 |
Last Update Date | 22/01/2009 |