Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 35.137219 | OH |
NPI | 1073035515 |
---|---|
Provider Name | Dr. Juan Domingo Garisto Risco |
First Address | Boston, MA 02132-4927 |
Second Address | Cleveland, OH 44195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2017 |
Last Update Date | 02/04/2020 |