Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN 20246 | FL |
NPI | 1003248824 |
---|---|
Provider Name | Dr. Idelbis Lago-Sanchez |
First Address | West Palm Beach, FL 33406-6820 |
Second Address | Palm Springs, FL 33461-4033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2013 |
Last Update Date | 01/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009877200 | (05) | FL |