Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP773 | CA |
NPI | 1013542976 |
---|---|
Provider Name | Sarah Lisabeth St John |
First Address | San Diego, CA 92128-2127 |
Second Address | San Diego, CA 92128-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2020 |
Last Update Date | 14/04/2020 |