Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 008504 | CT |
NPI | 1073047973 |
---|---|
Provider Name | Rebeca Maria Collado |
First Address | Stamford, CT 06901-2902 |
Second Address | Stamford, CT 06902-6216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2017 |
Last Update Date | 18/04/2017 |