Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 71274 |
NPI | 1013360585 |
---|---|
Provider Name | Veronica M Lopez |
First Address | Montebello, CA 90640-2311 |
Second Address | Montebello, CA 90640-2311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2016 |
Last Update Date | 19/07/2016 |