Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1033517198 |
---|---|
Provider Name | Reanna Rodriguez |
First Address | Antioch, CA 94531-8385 |
Second Address | Oakland, CA 94601-2313 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2014 |
Last Update Date | 05/12/2014 |