Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 66526 | CA |
NPI | 1174995252 |
---|---|
Provider Name | Marcilla Silva |
First Address | Lake Elsinore, CA 92530-3223 |
Second Address | Lake Elsinore, CA 92530-3223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 28/10/2015 |