Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 9192 | PR |
NPI | 1780605345 |
---|---|
Provider Name | Dr. Jesus Miguel Vidal |
First Address | San Juan, PR 00921 |
Second Address | Caguas, PR 00725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 04/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8-3244 | SSS (01) | PR |
E81604 | (02) | PR |