Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 241562 | MA |
N | 2080P0202X | Pediatric Cardiologist | 241562 | MA |
NPI | 1023045127 |
---|---|
Provider Name | Dr. Diego Porras Ingouville |
First Address | Boston, MA 02115 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
620476822 | TAX ID (01) |