Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 29534 | CA |
NPI | 1023332012 |
---|---|
Provider Name | Sharon Shirado |
First Address | San Rafael, CA 94901-5716 |
Second Address | San Rafael, CA 94901-5716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 18/03/2010 |