Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 4120 | PR |
NPI | 1245225614 |
---|---|
Provider Name | Carlos J Bourdony-Baez |
First Address | San Juan, PR 00910-2121 |
Second Address | San Juan, PR 00909-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 08/02/2016 |