Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 12922 | PR |
NPI | 1003955501 |
---|---|
Provider Name | Dr. Aida M Lizasoain Santiago |
First Address | Rio Piedras, PR 00925-3028 |
Second Address | Rio Piedras, PR 00925-3028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 03/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012589 | HUMANA (01) | PR |
03220 | AMERICAN HEALTH (01) | PR |
20136 | SSS (01) | PR |
500360E | MMM (01) | PR |
5884 | IMC (01) | PR |
H51502 | (02) | PR |