Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 58886 | CA |
NPI | 1073714085 |
---|---|
Provider Name | Mrs. Denise Patricia Gallegos |
First Address | Commerce, CA 90022-5403 |
Second Address | Commerce, CA 90022-5403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
58886 | REGISTERED DENTAL ASSISTA (01) | CA |