| NPI | 1760809354 |
|---|---|
| Former Name | CARLA LUCIA CHAVEZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401411881) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2020-10-13 |