Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 80314 | CA |
NPI | 1003259839 |
---|---|
Provider Name | Mrs. Hilda Jeanette Garza |
First Address | Sanger, CA 93657 |
Second Address | Clovis, CA 93612-3985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 11/04/2013 |