Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 61378 | CA |
NPI | 1023254885 |
---|---|
Provider Name | William Rosales |
First Address | Glendale, CA 91207-1968 |
Second Address | Van Nuys, CA 91405-2626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2008 |
Last Update Date | 29/12/2008 |