Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1083375687 |
---|---|
Provider Name | Noemi Villa |
First Address | Pleasanton, CA 94588-2830 |
Second Address | Pleasanton, CA 94588-2830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2022 |
Last Update Date | 05/01/2022 |