Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 61863 | CA |
NPI | 1235371774 |
---|---|
Provider Name | Ms. Tiffany Patrice Tobios |
First Address | Bellflower, CA 90706-6226 |
Second Address | South Gate, CA 90280-6167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2009 |
Last Update Date | 30/03/2009 |