Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H1801 | AZ |
NPI | 1013112747 |
---|---|
Provider Name | Ms. Jenny Ann Zamora-Garcia |
First Address | Flagstaff, AZ 86001-5623 |
Second Address | Flagstaff, AZ 86004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 08/07/2007 |