Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 00204075 | CO |
NPI | 1508428434 |
---|---|
Provider Name | Margaret Chavez |
First Address | Alamosa, CO 81101-2406 |
Second Address | La Jara, CO 81140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2019 |
Last Update Date | 01/07/2019 |