Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 50488 | CA |
NPI | 1356879225 |
---|---|
Provider Name | Mrs. Lilibeth Macaraeg Francisco |
First Address | Cerritos, CA 90703 |
Second Address | Buena Park, CA 90620-3271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2017 |
Last Update Date | 23/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50488 | (05) | CA |