Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 24861 | CA |
Y | 124Q00000X | Dental Hygienist | 455 | CA |
NPI | 1003154808 |
---|---|
Provider Name | Veronica Cabal Guevarra |
First Address | Murrieta, CA 92563-8439 |
Second Address | Murrieta, CA 92563-8439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2013 |
Last Update Date | 24/09/2018 |