Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 72203 | CA |
NPI | 1346893526 |
---|---|
Provider Name | Marta Lidia Garcia Sandoval |
First Address | Lawndale, CA 90260-1317 |
Second Address | Lawndale, CA 90260-1317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2019 |
Last Update Date | 17/07/2019 |