Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 75275 |
NPI | 1194365882 |
---|---|
Provider Name | Maria Guadalupe Sepulveda |
First Address | Perris, CA 92570-1649 |
Second Address | Riverside, CA 92503-5271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2020 |
Last Update Date | 09/01/2020 |