Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 008995 | CT |
NPI | 1023666534 |
---|---|
Provider Name | Mrs. Cynthia Ivette Mateo |
First Address | West Haven, CT 06516-2019 |
Second Address | West Haven, CT 06516-2019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2019 |
Last Update Date | 28/08/2019 |