Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2816 | PR |
NPI | 1003071754 |
---|---|
Provider Name | Dr. Elsa Cristina Justiniano |
First Address | San Juan, PR 00918 |
Second Address | Humacao, PR 00791-4269 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2008 |
Last Update Date | 22/07/2008 |