Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 26712 | CA |
NPI | 1073852398 |
---|---|
Provider Name | Kaitlyn Alise Tarbert |
First Address | Los Angeles, CA 90046-4999 |
Second Address | Los Angeles, CA 90046-4999 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2013 |
Last Update Date | 30/11/2016 |