Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1033724794 |
---|---|
Provider Name | Ana Garcia Velazco |
First Address | Carlisle, PA 17013-5095 |
Second Address | Carlisle, PA 17013-5095 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |