Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 14796 | PR |
NPI | 1003879883 |
---|---|
Provider Name | Antonio Radames Alvarez |
First Address | Juana Diaz, PR 00795 |
Second Address | Ponce, PR 00716-1115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 27/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H95613 | (02) | PR |