Individual
LEESETTE DE SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
6130 CAMINO REAL #12, RIVERSIDE, CA 92509
(951) 224-2253
Mailing address
6130 CAMINO REAL #12, RIVERSIDE, CA 92509
(951) 224-2253
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
60639
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60639
—
CA
Enumeration date
10/25/2016
Last updated
10/25/2016
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