Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 58449 | CA |
NPI | 1366929481 |
---|---|
Provider Name | Miss Estela Ramirez-Cotonieto I |
First Address | El Monte, CA 91731-1736 |
Second Address | Covina, CA 91722-1257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2018 |
Last Update Date | 21/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
58449 | (05) | CA |