Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 100831 | CA |
NPI | 1013466630 |
---|---|
Provider Name | Samantha Aguirre |
First Address | Corning, CA 96021-3352 |
Second Address | Corning, CA 96021-3352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2016 |
Last Update Date | 23/09/2016 |