Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH28686 | FL |
NPI | 1043979826 |
---|---|
Provider Name | Susan Diane Galvis |
First Address | Tampa, FL 33614-2409 |
Second Address | Tampa, FL 33614-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 09/12/2021 |