Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 33239 | CA |
NPI | 1003432261 |
---|---|
Provider Name | Sonya Portillo |
First Address | North Hollywood, CA 91606-1402 |
Second Address | North Hollywood, CA 91606-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2020 |
Last Update Date | 23/06/2020 |