Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 9324 | PR |
NPI | 1336218700 |
---|---|
Provider Name | Dr. Edna M Mora Pinero |
First Address | San Juan, PR 00927-4120 |
Second Address | San Juan, PR 00927-4120 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 22/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9324 | STATE LICENSE (01) | PR |
F62314 | (02) | PR |