Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 004801 | PR |
NPI | 1366918799 |
---|---|
Provider Name | Zuleima Nieves De Jesus |
First Address | Patillas, PR 00723 |
Second Address | Patillas, PR 00723-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 24/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123377 | REGISTRY ID NO. (01) | PR |