Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 22HI01108400 | NJ |
NPI | 1063032381 |
---|---|
Provider Name | Lisbeth Jimenez |
First Address | Union, NJ 07083-7571 |
Second Address | Union, NJ 07083-7571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2020 |
Last Update Date | 17/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22HI01108400 | NJ BOARD OF DENTISTRY (01) | NJ |