| NPI | 1639607195 |
|---|---|
| Former Name | GLORIA MAITE CORONADO MENDEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 10580) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2018-11-15 |