Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 79344 | CA |
NPI | 1164900809 |
---|---|
Provider Name | Patricia Michelle Campbell |
First Address | Riverside, CA 92507-7228 |
Second Address | Norco, CA 92860-2402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2018 |
Last Update Date | 03/08/2018 |