Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 180 | CA |
NPI | 1003010190 |
---|---|
Provider Name | Ms. Susan G. Dragoo |
First Address | Rancho Palos Verdes, CA 90275-2039 |
Second Address | Rancho Palos Verdes, CA 90275-2039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 08/07/2007 |