Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1376874107 |
---|---|
Provider Name | Melissa Lemus |
First Address | Riverside, CA 92503-5225 |
Second Address | Riverside, CA 92503-5225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2010 |
Last Update Date | 18/01/2010 |