Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 243945 | NY |
NPI | 1275860611 |
---|---|
Provider Name | Dr. Elizabeth De La Riva-Velasco |
First Address | Hawthorne, NY 10532-1533 |
Second Address | Hawthorne, NY 10532-2140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2009 |
Last Update Date | 23/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03249832 | (05) | NY |