Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 073 | PR |
NPI | 1235390519 |
---|---|
Provider Name | Dennis F Maza Bodee |
First Address | Isla Verde, PR 00979 |
Second Address | Carolina, PR 00979-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 19/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
48086 | (02) | PR |