Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 30318 | CA |
NPI | 1043812902 |
---|---|
Provider Name | Mary Beb Z. Quijano |
First Address | Fairfield, CA 94534-1486 |
Second Address | Fairfield, CA 94534-1486 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2020 |
Last Update Date | 14/11/2020 |