Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 3072 | PR |
NPI | 1356378004 |
---|---|
Provider Name | Caroll Zayas |
First Address | Toa Baja, PR 00949-4419 |
Second Address | Toa Baja, PR 00949-4419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |