Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | FDO36977 | MI |
N | 208D00000X | General Practice Physician | 4301036977 | MI |
NPI | 1689742397 |
---|---|
Provider Name | Dr. Fanny Aguirre Dela Cruz |
First Address | Livonia, MI 48152-3104 |
Second Address | Livonia, MI 48152-3104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2006 |
Last Update Date | 23/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1788503 | (05) | MI |