Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA89293 | CA |
NPI | 1275030306 |
---|---|
Provider Name | Vanessa Tovar |
First Address | Pomona, CA 91766-7015 |
Second Address | Pomona, CA 91766-7015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2018 |
Last Update Date | 05/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RDA89293 | (05) | CA |