Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist |
NPI | 1285178681 |
---|---|
Provider Name | Sonia Estrada |
First Address | Juarez, CHIHUAHUA 32543 |
Second Address | Juarez, CHIHUAHUA 32543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 05/12/2016 |