Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 199550 | NJ |
NPI | 1285180893 |
---|---|
Provider Name | Adelina Ibanez |
First Address | Alexandria, VA 22314-3674 |
Second Address | El Paso, TX 79920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |