Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 3660 | MA |
NPI | 1083974604 |
---|---|
Provider Name | Maria Carolina Yanosy |
First Address | Everett, MA 02149-5923 |
Second Address | Everett, MA 02149-5923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2012 |
Last Update Date | 17/05/2012 |