Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 18072 | CA |
NPI | 1053855635 |
---|---|
Provider Name | Liliana Romine |
First Address | San Jose, CA 95148-2071 |
Second Address | Gilroy, CA 95020-3537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2016 |
Last Update Date | 15/12/2016 |