Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | CA |
NPI | 1073840252 |
---|---|
Provider Name | Ms. Joanna Joyce Carrillo |
First Address | Riverside, CA 92503-5225 |
Second Address | Riverside, CA 92503-5225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2009 |
Last Update Date | 10/11/2009 |