Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA87311 | CA |
NPI | 1346712874 |
---|---|
Provider Name | Paula Felicia Aguirre |
First Address | Fresno, CA 93720-2698 |
Second Address | Fresno, CA 93720-2698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2018 |
Last Update Date | 21/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D8175302 | DENTAL (01) | CA |