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Individual
DR. REBECCA A CORNILLE
Active
Individual
DR. REBECCA A CORNILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
54087
CA
122300000X
Dentist
60530
KS
1223G0001X
General Practice Dentistry
2004014730
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FHC70961F
MEDI-CAL
—
Enumeration date
09/07/2006
Last updated
12/12/2011
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