Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA89173 | CA |
NPI | 1245905413 |
---|---|
Provider Name | Monika Yvonne Sierra |
First Address | Sylmar, CA 91342-4145 |
Second Address | Sylmar, CA 91342-4145 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2021 |
Last Update Date | 10/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA89173 | (05) | CA |