Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 14891 | CA |
NPI | 1023433323 |
---|---|
Provider Name | Mrs. Hilcia E. Moreno-Dasilva |
First Address | Encino, CA 91316-1115 |
Second Address | Encino, CA 91316-1115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2014 |
Last Update Date | 23/02/2014 |