Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 954505783 | CA |
NPI | 1245585819 |
---|---|
Provider Name | Dr. Dianne Bentley |
First Address | Pasadena, CA 91104-1615 |
Second Address | Pasadena, CA 91104-1615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2012 |
Last Update Date | 19/07/2012 |