Individual
MARTHA OLGA ROSAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DENTAL
Contact information
Practice address
14382 CHATSWORTH DR, SAN FERNANDO, CA 91340-4307
(818) 401-5191
Mailing address
14382 CHATSWORTH DR, SAN FERNANDO, CA 91340-4307
(818) 401-5191
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
68267
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68267
—
CA
Enumeration date
07/26/2017
Last updated
07/26/2017
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