Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 132 | PR |
NPI | 1013090315 |
---|---|
Provider Name | Carlos Padilla-Torres |
First Address | Ponce, PR 00716-2815 |
Second Address | Humacao, PR 00791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T26857 | (02) | PR |