Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA90318 | CA |
NPI | 1245866656 |
---|---|
Provider Name | Mr. Fernando Pedroza JR. |
First Address | Gilroy, CA 95020-6123 |
Second Address | Gilroy, CA 95020-6123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2020 |
Last Update Date | 17/03/2020 |