Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 81391 | CA |
NPI | 1033660816 |
---|---|
Provider Name | Heather Amador |
First Address | Corona, CA 92879-5744 |
Second Address | Corona, CA 92879-5744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2016 |
Last Update Date | 17/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA81391 | (05) | CA |