Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 17985 | PR |
NPI | 1023322260 |
---|---|
Provider Name | Dr. Huber A Tavarez Gonzalez |
First Address | Isabela, PR 00662-1927 |
Second Address | Isabela, PR 00662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2010 |
Last Update Date | 11/02/2015 |