Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 67515 | CA |
NPI | 1366059123 |
---|---|
Provider Name | Mrs. Mari Kris Columna |
First Address | Oceanside, CA 92057-1830 |
Second Address | Oceanside, CA 92057-1830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2020 |
Last Update Date | 25/09/2020 |