Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP697 | CA |
NPI | 1043791403 |
---|---|
Provider Name | Maricruz Barba |
First Address | San Diego, CA 92126-3568 |
Second Address | San Diego, CA 92126-3568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |