Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDHAP281 | CA |
NPI | 1033431630 |
---|---|
Provider Name | Mrs. Elmezen Oliverio Martin |
First Address | Lakeport, CA 95453-5704 |
Second Address | Lakeport, CA 95453-5704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2010 |
Last Update Date | 23/02/2010 |