Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 44094 | CA |
NPI | 1003052796 |
---|---|
Provider Name | Maria Irene Santiago |
First Address | Bell Gardens, CA 90201-3109 |
Second Address | Los Angeles, CA 90001-1771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2008 |
Last Update Date | 30/12/2008 |