Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH16236 | FL |
NPI | 1003033028 |
---|---|
Provider Name | Mrs. Adela I Vasquez |
First Address | Naranja, FL 33032 |
Second Address | Naranja, FL 33032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 09/07/2007 |