Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | 16793 | PR |
Y | 208D00000X | General Practice Physician | ACN1029 | FL |
NPI | 1023209251 |
---|---|
Provider Name | Dilcia I Hernandez Santana |
First Address | Orlando, FL 32807-4346 |
Second Address | Orlando, FL 32807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 25/06/2019 |