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General NPI Number Information
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NPI Number | 1447748199
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Entity Type | Individual
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Provider Name | MARY JANE DE LEON SALAPONG RDA
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Gender | Female
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Dates
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Enumeration Date | 04/27/2018
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Last Update Date | 04/27/2018
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Provider Practice Location Address
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Address Line | 2440 RIVER RD STE 140
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City | NORCO
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State | CA
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Zip | 92860-2402
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Country | US
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Telephone | 888-904-3204
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Fax |
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Provider Business Mailing Address
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Address Line | 34094 LADY FERN CT
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-2940
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Country | US
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Telephone | 949-483-0369
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | RDA58343
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License Number State | CA
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