Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 2222 | PR |
NPI | 1013157965 |
---|---|
Provider Name | Dr. Elba Cecilia Diaz Toro |
First Address | Carolina, PR 00979-6345 |
Second Address | Carolina, PR 00979-6345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2009 |
Last Update Date | 04/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2222 | PUERTO RICO STATE DENTIST LICENSE (01) | PR |