Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 025175-1 | NY |
NPI | 1073741294 |
---|---|
Provider Name | Edlin Cruz |
First Address | New York, NY 10026-2585 |
Second Address | New York, NY 10022-1236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2009 |
Last Update Date | 25/06/2009 |