Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 32932 | CA |
NPI | 1376782003 |
---|---|
Provider Name | Mr. Lorenzo Garnica |
First Address | Arleta, CA 91331-5255 |
Second Address | Valencia, CA 91355-0986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2009 |
Last Update Date | 19/02/2009 |