Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH11986 | CA |
NPI | 1063944999 |
---|---|
Provider Name | Linda Giordano Cannon |
First Address | Berkeley, CA 94703-2715 |
Second Address | Berkeley, CA 94703-2715 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2017 |
Last Update Date | 30/03/2017 |