Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1316561756 |
---|---|
Provider Name | Luz Valenzuela |
First Address | Canoga Park, CA 91303-1033 |
Second Address | Arleta, CA 91331-4115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2020 |
Last Update Date | 01/06/2020 |