Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 73720 | CA |
NPI | 1346735990 |
---|---|
Provider Name | Jessy Galindo |
First Address | South Gate, CA 90280-5060 |
Second Address | South Gate, CA 90280-5060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 26/06/2018 |