Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 5695 | PR |
NPI | 1184844094 |
---|---|
Provider Name | Dr. Alexis Pablos |
First Address | Luquillo, PR 00773-3005 |
Second Address | Fajardo, PR 00738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 12/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C77593 | (02) | PR |