Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 26921 | FL |
NPI | 1053903955 |
---|---|
Provider Name | Giovanna Bohorquez |
First Address | Tampa, FL 33626-3048 |
Second Address | Tampa, FL 33647-2434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2021 |
Last Update Date | 11/02/2021 |