Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 95523 | CA |
NPI | 1134714801 |
---|---|
Provider Name | Jasmin Martinez |
First Address | Los Angeles, CA 90042-1662 |
Second Address | Los Angeles, CA 90042-1662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2021 |
Last Update Date | 04/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
95723 | (05) | CA |