Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 9592 | PR |
NPI | 1003898818 |
---|---|
Provider Name | Aida L Quintero Noriega |
First Address | San Juan, PR 00901-2307 |
Second Address | Manati, PR 00674-4622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 19/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067525 | CRUZ AZUL (01) | |
E43973 | (02) |