Individual
EILEEN BOCHE MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13754 MIMI RD, VICTORVILLE, CA 92392-5539
(760) 684-5572
Mailing address
13754 MIMI RD, VICTORVILLE, CA 92392-5539
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
90405
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
90405
—
CA
Enumeration date
03/30/2021
Last updated
03/30/2021
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