Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 7036 | PR |
NPI | 1053776492 |
---|---|
Provider Name | Janice Torres |
First Address | Patillas, PR 00723-0000 |
Second Address | Patillas, PR 00723-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2015 |
Last Update Date | 30/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7036 | DENTAL ASSISTANT (01) | PR |