Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DN20001 | FL |
NPI | 1225377161 |
---|---|
Provider Name | Tatiana Lemes Caro Quintiliano |
First Address | Plantation, FL 33322-4810 |
Second Address | Pompano Beach, FL 33062-4939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2013 |
Last Update Date | 13/02/2013 |