Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | LP03123 | RI |
Y | 111NI0900X | Internist | LP03123 | RI |
NPI | 1003223686 |
---|---|
Provider Name | Diana Silva Cantillo |
First Address | Pawtucket, RI 02860-4474 |
Second Address | Pawtucket, RI 02860-4474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2014 |
Last Update Date | 16/07/2014 |