Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 24303100916 | CA |
NPI | 1295071819 |
---|---|
Provider Name | Mrs. Irma Christina Salazar |
First Address | South Gate, CA 90280-6167 |
Second Address | South Gate, CA 90280-6167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2012 |
Last Update Date | 31/12/2012 |