Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2025854 | CO |
NPI | 1043896756 |
---|---|
Provider Name | Alejandra Garcia |
First Address | Center, CO 81125 |
Second Address | Center, CO 81125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2021 |
Last Update Date | 23/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2025854 | LICENSURE (01) | CO |