Individual
MRS. MARILYN LEYVA FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
410 BLANDING BLVD STE 6B, ORANGE PARK, FL 32073-5065
(904) 276-5950
(904) 276-5359
Mailing address
410 BLANDING BLVD STE 6B, ORANGE PARK, FL 32073-5065
(904) 276-5950
(904) 276-5359
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH24841
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DH24841
LICENSE NUMBER
FL
Enumeration date
11/25/2020
Last updated
11/25/2020
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