Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1285254359 |
---|---|
Provider Name | Sonya Ascencio |
First Address | Pacoima, CA 91331-1656 |
Second Address | Pacoima, CA 91331-1656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2020 |
Last Update Date | 20/04/2020 |