Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 12660 | PR |
NPI | 1033177761 |
---|---|
Provider Name | Dr. Alvia Ivette Varona |
First Address | Cabo Rojo, PR 00623-1381 |
Second Address | Hormigueros, PR 00660-1708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 08/07/2007 |