Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1366689648 |
---|---|
Provider Name | Miss Clara Angela De Silva Bermudez |
First Address | Santa Ana, CA 92705-3743 |
Second Address | Orange, CA 92867-7716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2009 |
Last Update Date | 08/01/2009 |