Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1376780627 |
---|---|
Provider Name | Jacqueline Lemus |
First Address | West Covina, CA 91792-2450 |
Second Address | Baldwin Park, CA 91706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2009 |
Last Update Date | 08/01/2009 |