Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH-1991 | HI |
NPI | 1023598018 |
---|---|
Provider Name | Ms. Jessica Lynn Dela Cruz Lozano |
First Address | Waipahu, HI 96797-2700 |
Second Address | Waianae, HI 96792-3128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2018 |
Last Update Date | 18/08/2018 |