Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 16188 | PR |
NPI | 1770570194 |
---|---|
Provider Name | Dr. Fernando M Del Amo |
First Address | Carolina, PR 00985-5672 |
Second Address | Carolina, PR 00985-5672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
160531 | DM (01) | PR |
16188 | CERTIFICACION (01) | PR |