Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 5965 | PR |
NPI | 1043289226 |
---|---|
Provider Name | Dr. Francisco Correa Jusino |
First Address | Canovanas, PR 00729-1457 |
Second Address | Canovanas, PR 00729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C77368 | (02) |