Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 24549 | CA |
N | 126800000X | Dental Assistant | 51629 | CA |
NPI | 1093952186 |
---|---|
Provider Name | Evelyn Soriano |
First Address | Arcadia, CA 91006-3776 |
Second Address | Arcadia, CA 91006-3776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2009 |
Last Update Date | 19/10/2009 |