Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 73799 | CA |
NPI | 1356768410 |
---|---|
Provider Name | Patricia Velasco |
First Address | Garden Grove, CA 92840-3147 |
Second Address | Garden Grove, CA 92840-3147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2014 |
Last Update Date | 26/03/2014 |