Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH4148 | NM |
NPI | 1053719336 |
---|---|
Provider Name | Emilia Queiroz |
First Address | Albuquerque, NM 87110-3935 |
Second Address | Albuquerque, NM 87110-3935 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2014 |
Last Update Date | 09/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DH4148 | DENTAL HYGIENE LICENSE (01) | NM |