Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA71318 | CA |
NPI | 1124583091 |
---|---|
Provider Name | Guadalupe Enriquez Pacheco |
First Address | Rosamond, CA 93560-6027 |
Second Address | Rosamond, CA 93560-6027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 05/02/2019 |