Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 105602 | CA |
NPI | 1003423286 |
---|---|
Provider Name | Dr. Radhika Makadia |
First Address | Corona, CA 92883-4936 |
Second Address | Corona, CA 92883-4936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2020 |
Last Update Date | 30/09/2020 |