Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | MD467299 | PA |
NPI | 1518209154 |
---|---|
Provider Name | Dr. Coralee Del Valle Mojica |
First Address | Philadelphia, PA 19107-3377 |
Second Address | Philadelphia, PA 19104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2013 |
Last Update Date | 29/08/2019 |