Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 001523 | PR |
NPI | 1265864961 |
---|---|
Provider Name | Dr. Jose Antonio Vivaldi-Oliver |
First Address | San Juan, PR 00919-4796 |
Second Address | San Juan, PR 00919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2013 |
Last Update Date | 05/08/2013 |