Tatiana Bojorquez Grijalva, RDA

Individual provider Active NPI Dental Assistant · La Puente, CA

NPI 1457733602 · NPPES record last updated Jun 24, 2015

Key facts

NPI
1457733602
Entity type
Individual (NPI type 1)
Primary specialty
Dental Assistant 126800000X
License
83071 (CA)
Practice address
808 Larimore Ave
La Puente, CA 91744-3028
Phone
(626) 261-6630
NPI assigned
Jun 24, 2015
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
83071CAMDPharmacist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Assistant 126800000X 83071 CA Yes

Addresses

Primary practice location

808 Larimore Ave
La Puente, CA 91744-3028

Mailing address

808 Larimore Ave
La Puente, CA 91744-3028
Phone (626) 261-6630

Other providers in La Puente, CA

All providers in La Puente, CA · Dental Assistant in California

Sources for this page

Verify at the official NPI Registry.