Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H05754 | AZ |
NPI | 1063960680 |
---|---|
Provider Name | Helen Ruiz |
First Address | Tucson, AZ 85706-7046 |
Second Address | Tucson, AZ 85706-7046 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2016 |
Last Update Date | 12/09/2016 |