Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 002680 | PR |
NPI | 1043291628 |
---|---|
Provider Name | Dr. Acisclo Miguel Marxuach |
First Address | Guaynabo, PR 00966-3120 |
Second Address | Guaynabo, PR 00966-3120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C-78003 | (02) |