Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 71380 | CA |
NPI | 1255773032 |
---|---|
Provider Name | Leah Retania Lira |
First Address | Glendale, CA 91204-2637 |
Second Address | Glendale, CA 91204-2637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 25/07/2013 |