Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 84934 | CA |
NPI | 1013571280 |
---|---|
Provider Name | Maria Valle |
First Address | Cypress, CA 90630-4570 |
Second Address | Cypress, CA 90630-4570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2019 |
Last Update Date | 23/04/2019 |