Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 34481 | TX |
NPI | 1093294852 |
---|---|
Provider Name | Karla Judith Sermeno De Castillo |
First Address | San Antonio, TX 78256-2002 |
Second Address | Austin, TX 78745-5320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2018 |
Last Update Date | 11/08/2018 |