Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 23047 | CA |
NPI | 1043554553 |
---|---|
Provider Name | Rachael Roberts |
First Address | Irvine, CA 92604-4755 |
Second Address | Irvine, CA 92604-4755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2012 |
Last Update Date | 21/11/2012 |