Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 89203 | CA |
NPI | 1306311634 |
---|---|
Provider Name | Miss Miles Bunoan |
First Address | Long Beach, CA 90810-2320 |
Second Address | Orange, CA 92867-7716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2018 |
Last Update Date | 13/10/2018 |