Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA91976 | CA |
NPI | 1205490364 |
---|---|
Provider Name | Mrs. Araceli Tapia |
First Address | Whittier, CA 90601-2609 |
Second Address | Buena Park, CA 90620-3271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 24/04/2019 |