Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 27254 | CA |
NPI | 1033301072 |
---|---|
Provider Name | Ms. Doris Jean Amaya |
First Address | Artesia, CA 90701-3881 |
Second Address | Artesia, CA 90701-3881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2007 |
Last Update Date | 14/08/2007 |