Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1124431846 |
---|---|
Provider Name | Ernesto Marin |
First Address | Orange, CA 92867-6647 |
Second Address | Orange, CA 92867-6647 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2014 |
Last Update Date | 10/06/2014 |