Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 19667 | PR |
NPI | 1043665631 |
---|---|
Provider Name | Dr. Juan Manuel Corchado |
First Address | Isabela, PR 00662-0662 |
Second Address | Isabela, PR 00662 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2016 |
Last Update Date | 17/03/2018 |