Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 1940 | PR |
NPI | 1154403608 |
---|---|
Provider Name | Dr. Angelita C Olazabal |
First Address | Guaynabo, PR 00966-2047 |
Second Address | Guaynabo, PR 00966 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 17/01/2016 |