Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 12114 | PR |
NPI | 1053387506 |
---|---|
Provider Name | Carlos A. Bujosa |
First Address | Guaynabo, PR 00969-5717 |
Second Address | Guaynabo, PR 00969-5717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 14/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H32892 | (02) | PR |