Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 1385 | PR |
N | 1223P0106X | Oral and Maxillofacial Pathology | 1385 | PR |
NPI | 1174511844 |
---|---|
Provider Name | Dr. Jose Gustavo Wiscovitch |
First Address | Mayaquez, PR 00681 |
Second Address | Aguadilla, PR 00603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 04/06/2013 |