Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH22461 | FL |
NPI | 1063184653 |
---|---|
Provider Name | Raquel Diaz |
First Address | Sebring, FL 33872-3346 |
Second Address | Sebring, FL 33870-2129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2021 |
Last Update Date | 01/10/2021 |