Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16698 | PR |
NPI | 1013040922 |
---|---|
Provider Name | Dr. Camille Acevedo Rosa |
First Address | San Sebastian, PR 00685-9503 |
Second Address | San Sebastian, PR 00685-9503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 28/01/2011 |