Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP481 | CA |
NPI | 1023449915 |
---|---|
Provider Name | Mrs. Gail Lois Medrano |
First Address | Palm Springs, CA 92262-7020 |
Second Address | Palm Springs, CA 92262-7020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2013 |
Last Update Date | 03/12/2013 |