Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 746-447 | PR |
NPI | 1003455023 |
---|---|
Provider Name | Dr. Ginalette Talavera Rodriguez |
First Address | Aguada, PR 00602-3167 |
Second Address | Aguada, PR 00602-3167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2019 |
Last Update Date | 23/12/2019 |