Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1348 | PR |
NPI | 1083694525 |
---|---|
Provider Name | Dr. Fanny Marie Garraton |
First Address | Guaynabo, PR 00970-7887 |
Second Address | San Juan, PR 00921-3628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 08/07/2007 |