Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 66928 | CA |
NPI | 1164906889 |
---|---|
Provider Name | Emmanuel Gabriel Solano |
First Address | Alhambra, CA 91803-3522 |
Second Address | Alhambra, CA 91803-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2018 |
Last Update Date | 19/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
66928 | (05) | CA |