Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DN0012605 | FL |
NPI | 1063520344 |
---|---|
Provider Name | Ms. Christine M Mrugala |
First Address | Tampa, FL 33618 |
Second Address | Tampa, FL 33618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2006 |
Last Update Date | 08/07/2007 |