Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 743 | PR |
NPI | 1306064431 |
---|---|
Provider Name | Maria A Ortiz |
First Address | Bayamon, PR 00960-9501 |
Second Address | Bayamon, PR 00960-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 08/07/2007 |