Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | D160300554 | WA |
NPI | 1316383615 |
---|---|
Provider Name | Roxanna Rangel |
First Address | Bothell, WA 98011 |
Second Address | Bothell, WA 98011-2943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2013 |
Last Update Date | 14/05/2013 |