Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10419 | TX |
NPI | 1073725834 |
---|---|
Provider Name | Judith Ortiz |
First Address | Universal City, TX 78148-3435 |
Second Address | Universal City, TX 78148-3435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |