Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 83161 | CA |
NPI | 1346617206 |
---|---|
Provider Name | Karla Vianney Esquivel Velazquez |
First Address | Sylmar, CA 91342-2535 |
Second Address | Sylmar, CA 91342-2535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2015 |
Last Update Date | 26/08/2015 |