Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 107080 | CA |
NPI | 1285399006 |
---|---|
Provider Name | Dr. Edna Loera |
First Address | Sanger, CA 93657-2053 |
Second Address | Fresno, CA 93721-1805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2021 |
Last Update Date | 05/11/2021 |