Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 45133 | CA |
NPI | 1043540164 |
---|---|
Provider Name | Dr. Rosa Peng |
First Address | Santa Ana, CA 92706-3929 |
Second Address | Riverside, CA 92505-1819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2010 |
Last Update Date | 02/08/2012 |