Individual
KIMBERLY CORONEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
82811
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82811
DENTAL BOARD OF CALIFORNIA
CA
Enumeration date
05/24/2018
Last updated
06/16/2018
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