Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 28024 | TX |
NPI | 1003254277 |
---|---|
Provider Name | Ofelia Perez-Hernandez |
First Address | Mission, TX 78572 |
Second Address | Mission, TX 78572-7576 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 22/07/2014 |