Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP79 | CA |
NPI | 1073651113 |
---|---|
Provider Name | Ms. Karen Anne Vincent |
First Address | Los Gatos, CA 95032-7607 |
Second Address | Los Gatos, CA 95032-7607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H00079-01 | (05) | CA |