Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 37282 | CA |
NPI | 1033409875 |
---|---|
Provider Name | Mrs. Veronica Luisa Hernandez |
First Address | Phillips Ranch, CA 91766-4767 |
Second Address | Phillips Ranch, CA 91766-4767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2011 |
Last Update Date | 13/04/2011 |