Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 80250 | CA |
NPI | 1134570583 |
---|---|
Provider Name | Jessica Carmenate |
First Address | Riverside, CA 92505-2430 |
Second Address | Riverside, CA 92505-2430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 27/06/2016 |