Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 22352 | TX |
NPI | 1003976259 |
---|---|
Provider Name | Maria Atique |
First Address | San Antonio, TX 78221-1535 |
Second Address | San Antonio, TX 78217-5504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |