Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1093950636 |
---|---|
Provider Name | Greicy Carolina Carvajal |
First Address | Miami, FL 33186-6791 |
Second Address | Miami, FL 33176-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 11/12/2008 |