Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 103121 | CA |
NPI | 1447811070 |
---|---|
Provider Name | Roop Mayall |
First Address | Antelope, CA 95843-6034 |
Second Address | Yuba City, CA 95991-3492 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 25/06/2019 |