Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DDS101514 | CA |
Y | 213EG0000X | General Practice | DDS101514 | CA |
NPI | 1003339805 |
---|---|
Provider Name | Ryann Elizabeth Vasquez |
First Address | Diamond Bar, CA 91789-3253 |
Second Address | Diamond Bar, CA 91789-3253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2017 |
Last Update Date | 24/07/2017 |