Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 10084 | NC |
NPI | 1760896260 |
---|---|
Provider Name | Dr. Magdalena Jaramillo Ruck |
First Address | Fort Defiance, AZ 86504-0589 |
Second Address | Fort Defiance, AZ 86504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 04/04/2017 |