Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 65647 | CA |
NPI | 1326501685 |
---|---|
Provider Name | Maria Luisa Estrada |
First Address | San Jacinto, CA 92583-5422 |
Second Address | Hemet, CA 92545-3617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2019 |
Last Update Date | 12/04/2019 |