Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | CA |
NPI | 1043456221 |
---|---|
Provider Name | Miss Desiree Vazquez |
First Address | Clovis, CA 93612-4690 |
Second Address | Clovis, CA 93612-3684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2008 |
Last Update Date | 18/12/2008 |