Individual
ANNIE KHOMMARATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1846 AMARGOSA DR, PALMDALE, CA 93551-5114
(818) 645-6069
Mailing address
1846 AMARGOSA DR, PALMDALE, CA 93551-5114
(818) 645-6069
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
79331
CA
Other
Enumeration date
02/23/2017
Last updated
02/23/2017
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