Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 5597972774 | CA |
NPI | 1235461203 |
---|---|
Provider Name | Greta Macias |
First Address | Fresno, CA 93725 |
Second Address | Fresno, CA 93725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2010 |
Last Update Date | 02/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5597972774 | DENTAL ASSISTANT (01) |