Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 012354 | CA |
Y | 124Q00000X | Dental Hygienist | 469 | CA |
NPI | 1013355783 |
---|---|
Provider Name | Toni Giacomini |
First Address | Dana Point, CA 92629-2652 |
Second Address | Dana Point, CA 92629-2652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2013 |
Last Update Date | 04/06/2013 |