Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 14312 | MD |
NPI | 1124396551 |
---|---|
Provider Name | Dr. Guadalupe Garcia Fay |
First Address | Fairfax, VA 22030-7963 |
Second Address | Baltimore, MD 21201-1510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2011 |
Last Update Date | 04/04/2016 |