Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 3839 | PR |
NPI | 1588666770 |
---|---|
Provider Name | Dr. Ivan Figueroa-Otero |
First Address | San Juan, PR 00912-3310 |
Second Address | San Juan, PR 00912-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C78110 | (02) | PR |