Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 69546 | CA |
NPI | 1184982365 |
---|---|
Provider Name | Nayche Bradford |
First Address | San Francisco, CA 94110-1210 |
Second Address | San Francisco, CA 94110-1210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2012 |
Last Update Date | 25/04/2012 |