Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 80797 | CA |
NPI | 1083072607 |
---|---|
Provider Name | Lauren Rae Ramos |
First Address | Covina, CA 91722-1257 |
Second Address | Covina, CA 91722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2016 |
Last Update Date | 10/02/2016 |