Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 57557 | CA |
NPI | 1255867982 |
---|---|
Provider Name | Tanesha Riley |
First Address | Paramount, CA 90723-2770 |
Second Address | Paramount, CA 90723-2770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2017 |
Last Update Date | 01/05/2017 |