Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 016534-S | OH |
NPI | 1033675988 |
---|---|
Provider Name | Racquel Montijo Montijo |
First Address | Parma, OH 44129-2816 |
Second Address | Parma, OH 44129-2816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2019 |
Last Update Date | 15/02/2019 |