Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 81824 | CA |
NPI | 1255953428 |
---|---|
Provider Name | Viridiana Pablo-Martinez |
First Address | Anaheim, CA 92804-2132 |
Second Address | Artesia, CA 90701-6628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2020 |
Last Update Date | 11/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
81824 | (05) | CA |