Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1223D0001X | CA |
NPI | 1760553457 |
---|---|
Provider Name | Ms. Bernadette Theresa Close |
First Address | Corona, CA 92883-9265 |
Second Address | Corona, CA 92883-9265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |