Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902015931 | MI |
NPI | 1003114471 |
---|---|
Provider Name | Miss Fabiola Zamudio |
First Address | Lincoln Park, MI 48146-4705 |
Second Address | Detroit, MI 48216-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2011 |
Last Update Date | 08/03/2011 |