Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1053619304 |
---|---|
Provider Name | Mr. Hector Gil JR. |
First Address | Los Angeles, CA 90025-1123 |
Second Address | South Gate, CA 90280-6167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2011 |
Last Update Date | 10/03/2011 |