Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 2922879 | CA |
NPI | 1427295047 |
---|---|
Provider Name | Dr. Claudia Nora Pena Gudino |
First Address | Calexico, CA 92231-4700 |
Second Address | Mexicali, BAJA CALIFORNIA 21130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2009 |
Last Update Date | 20/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MXI1001070 | ID PROVEEDOR (01) | CA |