Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 13906 | PR |
NPI | 1285715326 |
---|---|
Provider Name | Dr. Juan A Tosado Polanco |
First Address | Santa Isabel, PR 00757-9621 |
Second Address | Guayama, PR 00784 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 07/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H55737 | (02) | PR |