Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 90558 | CA |
NPI | 1144785478 |
---|---|
Provider Name | Jessica Flores |
First Address | Fresno, CA 93710-5282 |
Second Address | Fresno, CA 93710-5282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2019 |
Last Update Date | 31/01/2019 |