Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 5999 | PR |
NPI | 1013933043 |
---|---|
Provider Name | Dr. Elvia Grisselle Santiago Vazquez |
First Address | Carolina, PR 00983-1518 |
Second Address | Carolina, PR 00982-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 21/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E43309 | (02) | PR |