Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DTP531 | FL |
NPI | 1013205038 |
---|---|
Provider Name | Monica Fernandez |
First Address | Gainesville, FL 32608-8457 |
Second Address | Gainesville, FL 32610-0427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 11/07/2011 |