Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 1564 | PR |
NPI | 1316931892 |
---|---|
Provider Name | Dr. Jose T. Medina-Tollinche |
First Address | Bayamon, PR 00960-6037 |
Second Address | Bayamon, PR 00959-7279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 06/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C82718 | (02) |