Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA88848 | CA |
NPI | 1124633680 |
---|---|
Provider Name | Elizabeth Damaris Salazar |
First Address | Perris, CA 92571-7473 |
Second Address | Riverside, CA 92503-5225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2020 |
Last Update Date | 11/09/2020 |