Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 00798 | PR |
NPI | 1053504217 |
---|---|
Provider Name | Mrs. Daisy Del Carmen Malave |
First Address | Humacao, PR 00791-3249 |
Second Address | Humacao, PR 00791-3249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2007 |
Last Update Date | 21/08/2007 |