Individual
JEANETTE ROSALES BRISENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15610 TUSTIN VILLAGE WAY APT 5, TUSTIN, CA 92780-4942
(951) 207-8969
Mailing address
15610 TUSTIN VILLAGE WAY APT 5, TUSTIN, CA 92780-4942
(951) 207-8960
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
78260
CA
Other
Enumeration date
05/10/2016
Last updated
05/10/2016
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