Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 906131 | CO |
NPI | 1063729010 |
---|---|
Provider Name | Monica Santa Cruz |
First Address | Fort Lupton, CO 80621-1508 |
Second Address | Commerce City, CO 80022-4812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2010 |
Last Update Date | 10/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
906131 | CO LICENSE (01) | CO |