Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 102314 | CA |
NPI | 1003265604 |
---|---|
Provider Name | Dr. Bambi Mpiana |
First Address | Ontario, CA 91762-1134 |
Second Address | Ontario, CA 91762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2016 |
Last Update Date | 01/08/2018 |