Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH-3516-RST | ID |
NPI | 1063018273 |
---|---|
Provider Name | Alejandra Garcia |
First Address | Mountain Home, ID 83647-1911 |
Second Address | Mountain Home, ID 83647-3142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2020 |
Last Update Date | 11/12/2020 |