Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 75959 | CA |
NPI | 1043537848 |
---|---|
Provider Name | Jenny Beatriz Perez |
First Address | North Hills, CA 91343-3255 |
Second Address | Los Angeles, CA 90025-1123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 03/05/2010 |