Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 41171 | CA |
NPI | 1386733269 |
---|---|
Provider Name | Tina-Lise Curtis |
First Address | San Rafael, CA 94901-1762 |
Second Address | San Rafael, CA 94903-5216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |