Individual
LEBROCK SHYNNEL BLYSTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
4000 LA RICA AVE, STE D, BALDWIN PARK, CA 91706-3163
(626) 430-9171
Mailing address
4000 LA RICA AVE, STE D, BALDWIN PARK, CA 91706-3163
(626) 430-9171
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
83522
CA
Other
Enumeration date
11/18/2014
Last updated
11/18/2014
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