Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 30303 | CA |
NPI | 1063865509 |
---|---|
Provider Name | Rafael Ceja Ochoa |
First Address | Tustin, CA 92782-0221 |
Second Address | Tustin, CA 92782-0221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2016 |
Last Update Date | 20/07/2016 |