Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 854 | CA |
NPI | 1053079533 |
---|---|
Provider Name | Janean Sousa |
First Address | San Jose, CA 95128-3151 |
Second Address | San Jose, CA 95128-3151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2021 |
Last Update Date | 02/12/2021 |