Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 005495 | PR |
NPI | 1306402722 |
---|---|
Provider Name | Yarelis L Lebron-Bultron |
First Address | Patillas, PR 00723-0873 |
Second Address | Patillas, PR 00723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2019 |
Last Update Date | 10/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140539 | REGISTRY NUMBER (01) | PR |