Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 66932 | CA |
NPI | 1235362955 |
---|---|
Provider Name | Lorena Marin |
First Address | Inglewood, CA 90304-2625 |
Second Address | Inglewood, CA 90304-2625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2009 |
Last Update Date | 27/08/2009 |