Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 0401415817 | VA |
NPI | 1124368139 |
---|---|
Provider Name | Dr. Xiomara Yolanda Rivera Henrandez |
First Address | Dorado, PR 00646-4514 |
Second Address | Arlington, VA 22209-2509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2013 |
Last Update Date | 17/03/2018 |