Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 055008-1 | NY |
NPI | 1033441183 |
---|---|
Provider Name | Susan Yasrebi |
First Address | Tampa, FL 33609-4515 |
Second Address | Tampa, FL 33609-4515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2010 |
Last Update Date | 22/08/2015 |