Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 49703 | CA |
NPI | 1003009440 |
---|---|
Provider Name | Rekha Vontela |
First Address | Antioch, CA 94509-6065 |
Second Address | Antioch, CA 94509-6065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2007 |
Last Update Date | 10/10/2012 |