Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 70754 | CA |
NPI | 1376780569 |
---|---|
Provider Name | Dora Maria Romero |
First Address | Venice, CA 90291-3048 |
Second Address | Valencia, CA 91355-0986 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2009 |
Last Update Date | 09/01/2009 |