Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 52100 | CA |
NPI | 1508957390 |
---|---|
Provider Name | Dr. Natalia Petrova |
First Address | San Marcos, CA 92078-1136 |
Second Address | San Marcos, CA 92078-1136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |