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NPI Code Detail

MEDICARE: GUADALUPE LEZAMA DE SOLAR RDH

MEDICARE: GUADALUPE LEZAMA DE SOLAR RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist14868TX

General Provider Information

NPI Number : 1457853137
Entity Type Code : Individual
Provider Name (Legal Business Name) : GUADALUPE LEZAMA DE SOLAR RDH
Provider Business Mailing Address
First Line : 2018 W RUNDBERG LN APT 13D
Second Line :
City : AUSTIN
State : TX
Zip : 78758-5973
Country : US
Telephone Number : 979-219-6084
Fax Number :
Provider Business Practice Location Address
First Line : 2411 WILLIAMS DR STE 111
Second Line :
City : GEORGETOWN
State : TX
Zip : 78628-3268
Country : US
Telephone Number : 512-864-1445
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2018
Last Update Date : 03/08/2018

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Directions to “ GUADALUPE LEZAMA DE SOLAR RDH” Practice Location

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