Individual
MISS YESSENIA SOCORRO MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
104 N ROBIN PRIVADO, ONTARIO, CA 91764
(909) 455-3182
Mailing address
104 N ROBIN PRIVADO, ONTARIO, CA 91764-4110
(909) 455-3182
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
67920
CA
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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