Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 61135 | CA |
NPI | 1104204346 |
---|---|
Provider Name | Mr. Trinidad Carlos Rocha |
First Address | Arcadia, CA 91006-3750 |
Second Address | Arcadia, CA 91006-3750 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2015 |
Last Update Date | 07/05/2015 |