Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
N | 126800000X | Dental Assistant |
NPI | 1023682481 |
---|---|
Provider Name | Gafary Ibanez Valera |
First Address | Phoenix, AZ 85037-1735 |
Second Address | Phoenix, AZ 85037-1735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2021 |
Last Update Date | 19/05/2021 |