Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA65507 | CA |
NPI | 1144729021 |
---|---|
Provider Name | Maria Guadalupe Villarreal |
First Address | Gardena, CA 90247-2721 |
Second Address | Torrance, CA 90503-5501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2018 |
Last Update Date | 07/02/2018 |