Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | CA |
NPI | 1356959035 |
---|---|
Provider Name | Ricardo Velasco |
First Address | Whittier, CA 90602-2058 |
Second Address | Whittier, CA 90602-2058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2020 |
Last Update Date | 17/07/2020 |