Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 12971 | PR |
NPI | 1013932128 |
---|---|
Provider Name | Dr. Hector Antonio Latorre |
First Address | Ponce, PR 00730 |
Second Address | Ponce, PR 00730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I-10926 | (02) | PR |