Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 126800000X | Dental Assistant | D160049121 | WA |
NPI | 1144551003 |
---|---|
Provider Name | Ms. Carmen Marie Diaz |
First Address | Tacoma, WA 98409-2445 |
Second Address | Tacoma, WA 98409-2445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 15/01/2010 |