Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 71990 | CA |
NPI | 1376984518 |
---|---|
Provider Name | Mrs. Gabriela Quintero |
First Address | Los Angeles, CA 90025-1123 |
Second Address | Los Angeles, CA 90025-1123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2013 |
Last Update Date | 16/07/2013 |