Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 7382 | PR |
NPI | 1043223506 |
---|---|
Provider Name | Dr. Jose Jesus Larrauri Renta |
First Address | Coamo, PR 00769-1883 |
Second Address | Coamo, PR 00769-2501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 01/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D08472 | (02) |