Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PTL0009246 | CO |
NPI | 1407337694 |
---|---|
Provider Name | Dr. Emmanuel Hernandez Aniag |
First Address | Pueblo, CO 81008-2800 |
Second Address | Pueblo, CO 81001-1867 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2018 |
Last Update Date | 04/01/2022 |