Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 72755 | CA |
NPI | 1285257188 |
---|---|
Provider Name | Sylvia Noemi Rodriguez |
First Address | Lancaster, CA 93535-2708 |
Second Address | Lancaster, CA 93535-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2020 |
Last Update Date | 26/05/2020 |