Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 18204 | PR |
NPI | 1003079757 |
---|---|
Provider Name | Dr. Elena M Nogales Perez |
First Address | Guaynabo, PR 00969-0000 |
Second Address | Carolina, PR 00983-0000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 09/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18204 | LICENSE (01) | PR |