Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1101X | Ophthalmic Assistant |
NPI | 1720470727 |
---|---|
Provider Name | Ambrosia Santana |
First Address | Chantilly, VA 20152-5966 |
Second Address | Chantilly, VA 20152-5966 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2015 |
Last Update Date | 01/10/2020 |