Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0016355 | TX |
NPI | 1073819447 |
---|---|
Provider Name | Monica Lamar Delagarza |
First Address | San Antonio, TX 78221-3117 |
Second Address | San Antonio, TX 78221-3117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2011 |
Last Update Date | 02/02/2011 |