Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 59939 | CA |
NPI | 1093952202 |
---|---|
Provider Name | Sara Gonzalez |
First Address | La Puente, CA 91744-6109 |
Second Address | Baldwin Park, CA 91706-3163 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2009 |
Last Update Date | 09/01/2009 |