Individual
JIA HULBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1207 W 144TH ST APT 3, GARDENA, CA 90247-2540
(818) 434-5735
Mailing address
1207 W 144TH ST APT 3, GARDENA, CA 90247-2540
(818) 434-5735
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA94824
CA
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RDA94824
—
CA
Enumeration date
07/17/2020
Last updated
07/17/2020
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