Individual
SANDRA YANIRA GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3380 LA SIERRA AVE STE 108, RIVERSIDE, CA 92503-5225
(951) 465-6982
Mailing address
12665 SERRANO DR, YUCAIPA, CA 92399-1744
(714) 559-8503
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA78245
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RDA78245
—
CA
Enumeration date
01/22/2019
Last updated
01/22/2019
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