Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 186-10222007100 | CA |
NPI | 1316242274 |
---|---|
Provider Name | Guillermina Rodriguez |
First Address | Gardena, CA 90247-2042 |
Second Address | Torrance, CA 90505-2408 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2011 |
Last Update Date | 24/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
186-10222007100 | DENTAL ASSISTANT (01) | CA |