Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 05312TG | TX |
NPI | 1003881574 |
---|---|
Provider Name | Maria Quintanilla |
First Address | Round Rock, TX 78681-2453 |
Second Address | Taylor, TX 76574-4975 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 25/07/2013 |