Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16983 | PR |
NPI | 1043494909 |
---|---|
Provider Name | Dr. Jenny Ivelisse Matias Ramos |
First Address | Jayuya, PR 00664-0897 |
Second Address | Jayuya, PR 00664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 31/01/2011 |