Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 12830 | PR |
NPI | 1053578849 |
---|---|
Provider Name | Dr. Glorimar Matta - Rodriguez |
First Address | San German, PR 00683 |
Second Address | San German, PR 00683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 26/11/2008 |