Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA88355 | CA |
NPI | 1255828208 |
---|---|
Provider Name | Kara Ashley Busell |
First Address | Menifee, CA 92584-2618 |
Second Address | Menifee, CA 92584-6805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2018 |
Last Update Date | 16/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA88355 | (05) | CA |