Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 20150624005 | FL |
NPI | 1326418179 |
---|---|
Provider Name | Leticia Ruiz Maturana |
First Address | Homestead, FL 33031 |
Second Address | Homestead, FL 33031-3628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 05/10/2015 |