Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 57324 | CA |
N | 126800000X | Dental Assistant | 63088 | CA |
NPI | 1376790725 |
---|---|
Provider Name | Chaficath Tatiana Aponte |
First Address | Gallup, NM 87305-1337 |
Second Address | Gallup, NM 87301-5748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2008 |
Last Update Date | 28/09/2009 |