Individual
MARTHA BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3328 ROLLINGRIDGE AVE, PALMDALE, CA 93550-1309
(818) 554-7245
Mailing address
3328 ROLLINGRIDGE AVE, PALMDALE, CA 93550-1309
(818) 554-7245
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
73-01201
CA
Other
Enumeration date
07/31/2009
Last updated
07/31/2009
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