Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 71-000199 | OH |
NPI | 1235323627 |
---|---|
Provider Name | Dr. Ysidora Torrealba |
First Address | Columbus, OH 43240-4001 |
Second Address | Columbus, OH 43210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2007 |
Last Update Date | 29/08/2007 |