Individual
CANDICE RENEE PATRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12121 WILSHIRE BLVD STE 111, LOS ANGELES, CA 90025-1123
(310) 897-3401
Mailing address
12121 WILSHIRE BLVD STE 111, LOS ANGELES, CA 90025-1123
(310) 897-3401
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
80290
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80290
—
CA
Enumeration date
05/13/2021
Last updated
05/13/2021
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