Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH 20834 | CA |
NPI | 1033651518 |
---|---|
Provider Name | Silvia Karina Zepeda-Molina |
First Address | Santa Rosa, CA 95403-9006 |
Second Address | Sonoma, CA 95476-5414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2016 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1770669715 | MEDI-CAL FQHC (01) | CA |