Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 71964 | CA |
NPI | 1053558882 |
---|---|
Provider Name | Sandra Corona Gonzalez |
First Address | Lancaster, CA 93534-3333 |
Second Address | Lancaster, CA 93534-2592 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2009 |
Last Update Date | 15/01/2009 |