Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP763 | CA |
NPI | 1033749361 |
---|---|
Provider Name | Miriam Caraveo |
First Address | West Covina, CA 91792-1758 |
Second Address | West Covina, CA 91792-1758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2020 |
Last Update Date | 26/01/2020 |