Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1184933491 |
---|---|
Provider Name | Surrell Falcon |
First Address | Lancaster, CA 93534-3333 |
Second Address | Lancaster, CA 93534-3333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2010 |
Last Update Date | 04/10/2010 |