Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H8106 | OR |
NPI | 1063188738 |
---|---|
Provider Name | Norma Santiago Hernandez |
First Address | Portland, OR 97203-5203 |
Second Address | Portland, OR 97239-3868 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2021 |
Last Update Date | 21/08/2021 |