Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 19660 | PR |
N | 2086S0120X | Pediatric Surgery | 57.027307 | OH |
NPI | 1639625783 |
---|---|
Provider Name | Astrid Rocio Soares Medina |
First Address | Columbus, OH 43215-3169 |
Second Address | Mayaguez, PR 00681-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2016 |
Last Update Date | 10/07/2019 |