Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 54664 | CA |
Y | 1223D0001X | Dental Public Health | 54664 | CA |
NPI | 1659430718 |
---|---|
Provider Name | Dr. Nathalie C Selvanathan |
First Address | Visalia, CA 93291-6331 |
Second Address | Visalia, CA 93291-5014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 30/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54664 | LICENSE (01) | CA |