Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 8720 | PR |
NPI | 1093715997 |
---|---|
Provider Name | Dr. Grace Rullan |
First Address | Guaynabo, PR 00966-3042 |
Second Address | Toa Baja, PR 00949-3637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 04/12/2015 |