Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 50688 | CA |
NPI | 1245608165 |
---|---|
Provider Name | Mrs. Norma Angelica Lira |
First Address | Upland, CA 91786-4021 |
Second Address | Upland, CA 91786-4021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2015 |
Last Update Date | 09/09/2015 |