Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0402205095 | VA |
N | 124Q00000X | Dental Hygienist | HYG1000641 | DC |
NPI | 1003282633 |
---|---|
Provider Name | Liliana Fernandez |
First Address | Alexandria, VA 22306-6647 |
Second Address | Alexandria, VA 22306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2015 |
Last Update Date | 23/08/2018 |