Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA94837 | CA |
NPI | 1104449511 |
---|---|
Provider Name | Noemi Paredes |
First Address | Los Angeles, CA 90011-2889 |
Second Address | Los Angeles, CA 90011-2889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2020 |
Last Update Date | 19/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA94837 | (05) | CA |