Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA69102 | CA |
NPI | 1235493057 |
---|---|
Provider Name | Guadalupe Maria Magana |
First Address | El Monte, CA 91733-2826 |
Second Address | Paramount, CA 90723-3638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 26/06/2012 |