Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 212-E | PR |
NPI | 1073863833 |
---|---|
Provider Name | Dr. Jorge Mendoza Torres |
First Address | San Juan, PR 00921 |
Second Address | San Juan, PR 00921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2012 |
Last Update Date | 19/09/2012 |