Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | AEF772 | CA |
NPI | 1063073237 |
---|---|
Provider Name | Felicia Roxana Dawkins Lewis |
First Address | Riverside, CA 92504-2603 |
Second Address | Norco, CA 92860-2402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |