Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 4977 | PR |
NPI | 1285630749 |
---|---|
Provider Name | Dr. Jose A Garcia-Vicario |
First Address | Ponce, PR 00717-1550 |
Second Address | Ponce, PR 00717-1550 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 14/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D08703 | (02) |