Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10823 | TX |
NPI | 1073953303 |
---|---|
Provider Name | Erika Lee Banuelos |
First Address | Brownsville, TX 78521-3527 |
Second Address | Brownsville, TX 78521-3527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2013 |
Last Update Date | 01/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10823 | DENTAL HYGIENIST LICENSE (01) | TX |