Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN011492 | GA |
NPI | 1033198858 |
---|---|
Provider Name | Dr. Damaries Candelariosoto |
First Address | San Juan, PR 00918-3015 |
Second Address | San Juan, PR 00918-3015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 01/07/2016 |