Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 7177 | PR |
NPI | 1063487171 |
---|---|
Provider Name | Dr. Ismael Toro Grajales |
First Address | Bayamon, PR 00961-6902 |
Second Address | Bayamon, PR 00961-6902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 10/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C78250 | (02) | PR |