Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA91193 | CA |
NPI | 1255971123 |
---|---|
Provider Name | Yesenia Lopez |
First Address | Perris, CA 92570-9086 |
Second Address | Perris, CA 92570-9086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2020 |
Last Update Date | 08/01/2020 |