Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist |
NPI | 1730239310 |
---|---|
Provider Name | Dr. Jairo De Jesus Castrolondono |
First Address | Flagstaff, AZ 86001-3118 |
Second Address | Flagstaff, AZ 86001-3118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 18/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
513757 | (05) | AZ |