Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 46410 | CA |
NPI | 1033755251 |
---|---|
Provider Name | Magdalena Victoria Bianchi |
First Address | Rialto, CA 92376-2417 |
Second Address | Rialto, CA 92376-2418 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2019 |
Last Update Date | 22/11/2019 |