Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 90611 | CA |
NPI | 1053920777 |
---|---|
Provider Name | Miss Julie R Quevedo |
First Address | Palmdale, CA 93552-4462 |
Second Address | Palmdale, CA 93552-4462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2020 |
Last Update Date | 28/07/2020 |