Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 83486 | CA |
NPI | 1366971962 |
---|---|
Provider Name | Sonia Tellez |
First Address | North Hills, CA 91343-2068 |
Second Address | North Hills, CA 91343-2234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2017 |
Last Update Date | 07/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
83486 | (05) | CA |