Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2262 | PR |
NPI | 1154412567 |
---|---|
Provider Name | Dr. Jeanne Michelle Badillo |
First Address | Humacao, PR 00792-9132 |
Second Address | San Juan, PR 00926-3072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 28/10/2021 |