Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 126800000X | Dental Assistant | 53900 | CA |
Y | 126800000X | Dental Assistant | 976 | CA |
NPI | 1194156828 |
---|---|
Provider Name | Kathleen De Vote |
First Address | Arcadia, CA 91006-3776 |
Second Address | Los Angeles, CA 90025-1123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2013 |
Last Update Date | 06/12/2013 |