Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 40196 | CA |
NPI | 1184075749 |
---|---|
Provider Name | Shirley Garner |
First Address | Los Angeles, CA 90025-1123 |
Second Address | Los Angeles, CA 90025-1123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2016 |
Last Update Date | 24/06/2016 |