Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | E-1D10R7 | FL |
NPI | 1295356756 |
---|---|
Provider Name | Argedith Fernandez |
First Address | Orlando, FL 32835-3501 |
Second Address | Orlando, FL 32835-3501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2020 |
Last Update Date | 28/05/2020 |