Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MA03422600 | NJ |
NPI | 1205959400 |
---|---|
Provider Name | Alicia T Tesoro |
First Address | Trenton, NJ 08618-4741 |
Second Address | Trenton, NJ 08618-4741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F13176 | (02) | NJ |