Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 19728 | PR |
NPI | 1003330697 |
---|---|
Provider Name | Alexis Torres Rodriguez |
First Address | Comerio, PR 00782-9560 |
Second Address | Guaynabo, PR 00782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2017 |
Last Update Date | 26/07/2017 |