Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 23762 | CA |
NPI | 1023274925 |
---|---|
Provider Name | Mruga Rajnikant Patel |
First Address | Corona, CA 92882-3540 |
Second Address | Corona, CA 92882-3540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 31/07/2008 |