Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 72529 | CA |
NPI | 1376084590 |
---|---|
Provider Name | Mireya Dee Santos |
First Address | Whittier, CA 90605-3421 |
Second Address | Whittier, CA 90605-3421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2017 |
Last Update Date | 20/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
72529 | (05) | CA |