Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 28715 | CA |
NPI | 1033877725 |
---|---|
Provider Name | Miss Amanda M Lourenco |
First Address | Fresno, CA 93711-4401 |
Second Address | Fresno, CA 93711-4401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2021 |
Last Update Date | 30/11/2021 |