Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA86440 | CA |
NPI | 1275151367 |
---|---|
Provider Name | Nicole Gracella Arredondo |
First Address | Rancho Dominguez, CA 90220-6823 |
Second Address | Rancho Dominguez, CA 90220-4976 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2020 |
Last Update Date | 06/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA86440 | (05) | CA |