Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH60386410 | WA |
NPI | 1063849529 |
---|---|
Provider Name | Clarissa Jimenez |
First Address | Othello, WA 99344-1040 |
Second Address | Othello, WA 99344-1040 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2013 |
Last Update Date | 30/09/2013 |