Individual
MARIFER HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1205 RENAISSANCE PKWY, RIALTO, CA 92376-2417
(909) 253-0490
Mailing address
15637 FERNDALE RD, VICTORVILLE, CA 92394-6707
(562) 419-9576
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
E1185783
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E1185783
—
CA
Enumeration date
02/23/2020
Last updated
02/23/2020
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