Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 49068 | CA |
NPI | 1164523668 |
---|---|
Provider Name | Silvia Cristina Mafra Cecchini |
First Address | Berkeley, CA 94705-1192 |
Second Address | Berkeley, CA 94705-1192 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 05/08/2008 |