Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 22075 | PR |
NPI | 1023619756 |
---|---|
Provider Name | Dr. Isennia Marin |
First Address | Isabela, PR 00662 |
Second Address | Isabela, PR 00662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2020 |
Last Update Date | 29/01/2021 |