Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 71314 | CA |
NPI | 1124265988 |
---|---|
Provider Name | Ms. Eva Elena Rivera |
First Address | Corona, CA 92883-0686 |
Second Address | Corona, CA 92883-0686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2009 |
Last Update Date | 27/02/2009 |