Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1235752809 |
---|---|
Provider Name | Karina Medina |
First Address | Sparks, NV 89431-3689 |
Second Address | Sparks, NV 89431-3689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2020 |
Last Update Date | 18/05/2020 |