Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 5016 | PR |
NPI | 1174629034 |
---|---|
Provider Name | Adrian Colon Laracuente |
First Address | San Juan, PR 00925-3607 |
Second Address | San Juan, PR 00925-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0028009 | SSS (01) | PR |