Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 39932 | CA |
NPI | 1326308529 |
---|---|
Provider Name | Monica Diaz |
First Address | Santa Ana, CA 92701 |
Second Address | Santa Ana, CA 92701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2012 |
Last Update Date | 22/05/2012 |