Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1784 | AZ |
N | 152W00000X | Optometrist | OPC4536 | FL |
NPI | 1013211598 |
---|---|
Provider Name | Dr. Diana Vega Hernandez |
First Address | Gilbert, AZ 85233-5265 |
Second Address | Glendale, AZ 85308-8539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2010 |
Last Update Date | 27/12/2010 |