Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 78818 | CA |
NPI | 1386022739 |
---|---|
Provider Name | Silvia Erika Hernandez |
First Address | Corona, CA 92882-4529 |
Second Address | Corona, CA 92882-4529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2015 |
Last Update Date | 18/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
78818 | DENTAL BOARD OF CALIFORNIA (01) | CA |