Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA63784 | CA |
NPI | 1205449451 |
---|---|
Provider Name | Rocio Frias |
First Address | Rancho Cucamonga, CA 91739-8730 |
Second Address | Corona, CA 92881-8653 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2020 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA63784 | (05) | CA |