Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00005699 | WA |
NPI | 1073735791 |
---|---|
Provider Name | Ruby Azcueta |
First Address | Renton, WA 98058-3804 |
Second Address | Seattle, WA 98118-2455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 08/07/2007 |