Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH11724 | FL |
NPI | 1053650655 |
---|---|
Provider Name | Alexandra M Urena |
First Address | Winter Haven, FL 33881-4672 |
Second Address | Lakeland, FL 33801-5237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2013 |
Last Update Date | 10/04/2019 |