Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 27777 | CA |
Y | 126800000X | Dental Assistant | 67522 | CA |
NPI | 1104264399 |
---|---|
Provider Name | Nancy Lopez |
First Address | Moreno Valley, CA 92551-9228 |
Second Address | Moreno Valley, CA 92551-9228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 26/08/2013 |