Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | CA |
NPI | 1184397879 |
---|---|
Provider Name | Guadalupe Perez Arreola |
First Address | Lake Elsinore, CA 92530-0508 |
Second Address | Corona, CA 92881-8653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2021 |
Last Update Date | 28/07/2021 |