Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 34908 | CA |
NPI | 1346773298 |
---|---|
Provider Name | Renee Regina Pimentel |
First Address | San Bernardino, CA 92411-1224 |
Second Address | Los Angeles, CA 90025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2017 |
Last Update Date | 07/04/2017 |