Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1174199624 |
---|---|
Provider Name | Leydis De Los Reyes |
First Address | Hialeah, FL 33012-7193 |
Second Address | Hialeah, FL 33012-7193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2021 |
Last Update Date | 03/06/2021 |