Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 25848 | CA |
NPI | 1063011120 |
---|---|
Provider Name | Mrs. Pamela Ann Reid-Williams |
First Address | San Diego, CA 92105-5207 |
Second Address | San Diego, CA 92105-5207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2020 |
Last Update Date | 20/10/2020 |