Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | HAP881 | CA |
NPI | 1073162657 |
---|---|
Provider Name | Ana Garcia Brady |
First Address | Atascadero, CA 93422-5346 |
Second Address | Atascadero, CA 93422-5346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 19/01/2022 |