Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA67481 | CA |
NPI | 1245756741 |
---|---|
Provider Name | Roberto Palmerin |
First Address | Lake Elsinore, CA 92530-4034 |
Second Address | Lake Elsinore, CA 92530-4034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 16/08/2017 |