Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 380 | CA |
NPI | 1063799823 |
---|---|
Provider Name | Mrs. Jacklyn Martirosyan |
First Address | Burbank, CA 91505 |
Second Address | Burbank, CA 91505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2011 |
Last Update Date | 08/11/2011 |