Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH15373 | FL |
NPI | 1063639458 |
---|---|
Provider Name | Ms. Claudia Elvira Canabal Perez |
First Address | Plantation, FL 33322-6462 |
Second Address | Sunrise, FL 33351-6963 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DH15373 | HYG LICENCE (01) | FL |