Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1073943676 |
---|---|
Provider Name | Latanya Washington |
First Address | Lancaster, CA 93535-3233 |
Second Address | Lancaster, CA 93535-3233 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2013 |
Last Update Date | 18/11/2013 |