Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 8625 | WA |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 00008625 | WA |
NPI | 1881704963 |
---|---|
Provider Name | Rachelle A Retoma |
First Address | El Paso, TX 79934-4117 |
Second Address | El Paso, TX 79920-5002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 01/06/2016 |