Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22125 | FL |
NPI | 1003269077 |
---|---|
Provider Name | Dr. Efren Ormaza |
First Address | Tampa, FL 33606-1817 |
Second Address | Tampa, FL 33619-2813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2016 |
Last Update Date | 14/07/2016 |