Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 96019 | CA |
NPI | 1275123788 |
---|---|
Provider Name | Jarvitz Mason |
First Address | San Gabriel, CA 91776-3207 |
Second Address | San Gabriel, CA 91776-3207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2021 |
Last Update Date | 20/01/2021 |