Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 63790 | CA |
NPI | 1104305556 |
---|---|
Provider Name | Federico S Cabatan |
First Address | Valencia, CA 91354-4927 |
Second Address | Valencia, CA 91354-4927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2018 |
Last Update Date | 07/08/2018 |