Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | SL6212 | CA |
NPI | 1184942203 |
---|---|
Provider Name | Mrs. Ashley Weston |
First Address | Antelope, CA 95843-5056 |
Second Address | Folsom, CA 95630-3822 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2010 |
Last Update Date | 13/05/2010 |