Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 90133 | CA |
NPI | 1225653488 |
---|---|
Provider Name | Mayra Alejandra Macias |
First Address | Orange, CA 92867-7716 |
Second Address | Orange, CA 92867-7716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2020 |
Last Update Date | 13/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90133 | (05) | CA |