Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA92560 | CA |
NPI | 1295385318 |
---|---|
Provider Name | Joanna Ibarra |
First Address | Riverside, CA 92503-5225 |
Second Address | Riverside, CA 92503-5225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2019 |
Last Update Date | 19/09/2019 |