Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH24516 | FL |
NPI | 1053872275 |
---|---|
Provider Name | Erika Hernandez |
First Address | San Diego, CA 92154 |
Second Address | San Diego, CA 92135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2019 |
Last Update Date | 29/03/2019 |