Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 71599 | CA |
NPI | 1306343447 |
---|---|
Provider Name | Erica Tovar |
First Address | Ontario, CA 91764-1811 |
Second Address | Ontario, CA 91762-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2018 |
Last Update Date | 06/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
71599 | (05) | CA |